Abstract
Abstract 3004FN2
Clofarabine (CLO), a second generation purine analogue, has demonstrated an efficient anti-leukemia activity while showing a favorable toxicity profile. The aim of our study was to analyse the results of CLO as part of the conditioning regimen prior to allo-SCT for the treatment of patients with AML or ALL. This retrospective multicenter report assessed the outcome of 90 patients who received a clofarabine-containing conditioning regimen allogeneic stem cell transplantation (allo-SCT) for AML (n=69) or ALL (n=21) between November 2006 and September 2010 and reported on the EBMT registry. The median age was 42 years (range: 18–69) at transplant. The majority of patients presented with an active disease at transplant (CR1 n=8; CR2 n=16, active disease n=66). All patients had received a CLO-containing conditioning regimen (RIC n=88; MAC n=2) with the following combinations: CLO/TBI n=27; CLO/Busulfan n=10; CLO/Busulfan/ATG n=32; CLO/others drugs n=21. With a median follow-up of 14 months (range: 1–45), 2-years OS, LFS, relapse incidence, non-relapse mortality (NRM) and chronic GVHD were 28+-5%, 23+-5%, 41+-6%, 35+-5% and 38+-7%, respectively. When comparing AML and ALL patients, OS and LFS were significantly higher for AML patients (OS: 35+-6% vs 0%, p<0.0001); LFS: 30+-6% vs 0%, p<0.0001). Overall, engraftment was achieved in 84% of patients with no difference between AML and ALL patients. Patients achieving CR from an active disease were 66.5% in AML vs 40% in ALL (p=0.06). Also, 2-year chronic GVHD was 35% in AML vs 17% in ALL, p=0.32. In a Cox multivariate analysis, AML was the only factor associated with a better LFS (HR=0.37; 95%CI: 0.21–0.66, P=0.001). We conclude that the use of CLO-containing conditioning regimen for allo-SCT is an effective treatment for high-risk AML patients as CLO seems to provide higher anti-tumor and alloreactivity effects. In high-risk ALL patients, disappointing results are observed. Prospective studies are needed to evaluate the potential role of CLO as part of reduced toxicity conditioning regimens in acute leukemias.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
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