Clofarabine, cyclophosphamide and etoposide as single-course re-induction therapy for children with refractory/multiple relapsed acute lymphoblastic leukaemia

Franco Locatelli, Anna M. Testi, Maria Ester Bernardo, Carmelo Rizzari, Alice Bertaina, Pietro Merli, Andrea Pession, Eugenia Giraldi, Rosanna Parasole, Walter Barberi, Marco Zecca

Research output: Contribution to journalArticlepeer-review

Abstract

The safety and efficacy of the combination clofarabine/cyclophosphamide/ etoposide were evaluated in children with advanced acute lymphoblastic leukaemia (ALL). The study enrolled 25 paediatric patients (median age 12·5 years) with either refractory (n = 17; 68%) or multiple relapsed (n = 8; 32%) ALL to receive clofarabine 40 mg/m 2, cyclophosphamide 400 mg/m 2 and etoposide 150 mg/m 2, daily for 5 consecutive days. No patient died from treatment-related complications. The most common adverse events were febrile neutropenia, mucositis and reversible liver toxicity; no case of liver veno-occlusive disease was reported. The overall remission rate was 56%: 13 patients (52%) achieved complete remission (CR) and one (4%) CR without platelet recovery (CRp). In seven of the 13 (54%) patients achieving CR, remissions were of sufficient duration to allow patients to receive allogeneic haematopoietic stem cell transplantation. The probability of CR/CRp was greater in the 17 patients with B cell precursor ALL than in the eight with T-ALL (76% vs. 12%, respectively, P <0·01). The 18-month overall survival probability was 39% and 0% in patients who did or did not respond to the treatment, respectively (P <0·01). These data suggest that the clofarabine/cyclophosphamide/etoposide regimen is well tolerated and can induce clinical response in a relevant proportion of children with refractory/multiple relapsed ALL.

Original languageEnglish
Pages (from-to)371-378
Number of pages8
JournalBritish Journal of Haematology
Volume147
Issue number3
DOIs
Publication statusPublished - Nov 2009

Keywords

  • Acute lymphoblastic leukaemia
  • Allogeneic haematopoietic stem cell transplantation
  • Childhood haematological malignancies
  • Clofarabine
  • Combination therapy
  • Refractory/relapsed disease

ASJC Scopus subject areas

  • Hematology

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