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- W2023113361 abstract "Patients with refractory leukemia entering allogeneic stem cell transplant (Allo-SCT) fare poorly, and higher disease burden correlates with decreased disease free survival (DFS) (van Besien, JCO 2005). To determine the feasibility of clofarabine (CLO) cytoreductive therapy as a bridge to Allo-SCT we retrospectively analyzed 14 heavily pretreated refractory acute myelogenous leukemia (AML) pts. All pts received CLO 30–40 mg/m2 intravenous daily for five consecutive days as bridging therapy with the intention to initiate Allo-SCT conditioning during the cytopenic phase, 14–21 days later. Pts had a mean of 2.2 prior treatment regimens, and 8 had primary refractory leukemia. 4 pts were relapsed following a prior stem cell transplant (1 autologous and 3 Allo-SCT). To assess CLO cytoreduction, bone marrow (BM) biopsy and aspirate were performed at the nadir, day 12 after CLO. Cytoreduction was defined as post CLO marrow with <20% cellularity and <10% blasts. CLO achieved cytoreduction in 8/14 pts. The median BM cellularity was 45% (4–90%) before and 5% (1–83%) after CLO. The median BM blast % was 23% (10%-100%) before and 6% (0%-90%) after CLO. Of the 14 pts, 13 proceeded to Allo-SCT by day 26 (median 22, range 17–26). 7 pts received a fludarabine, busulfan, campath regimen; 5 pts received fludarabine, melphalan with either ATG (2) or Campath (3); 1 pt received a TBI-based regimen. Grade 4 hyperbilirubinemia prevented one pt from proceeding to Allo-SCT preparative regimen. Of the 13 pts receiving Allo-SCT the median follow up is 15 months for survivors. 3 pts are alive and disease free at 4.3, 16.5, and 40 months after Allo-SCT, and all achieved CLO cytoreduction. 2 pts are alive with progressive disease at 8 and 15 months. The overall DFS at day 100 was 9/13. 3 pts relapsed before day 100, 2 of whom did not achieve cytoreduction. Beyond day 100 an additional 3 pts relapsed at 5.5, 5.5, and 6.5 months. 1 pt died of treatment related motality (TRM), sepsis, at day 17. The TRM at day 100 was 1/13, and 4/13 at one year. In conclusion, 13/14 patients with refractory AML were able to undergo Allo-SCT with acceptable TRM in this heavily pretreated group after CLO re-induction. Based on these data, we are pursuing a prospective feasibility study of CLO cytoreduction followed by Allo-SCT during the cytopenic phase." @default.
- W2023113361 created "2016-06-24" @default.
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- W2023113361 date "2008-02-01" @default.
- W2023113361 modified "2023-09-27" @default.
- W2023113361 title "159: Feasibility of Clofarabine Cytoreduction before Initiation of Allogeneic Stem Cell Transplant Regimen During the Cytopenic Phase for Patients with Refractory Acute Myelogenous Leukemia" @default.
- W2023113361 doi "https://doi.org/10.1016/j.bbmt.2007.12.168" @default.
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