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Conditioning Regimens

Allo-SCT conditioning for myelodysplastic syndrome and acute myeloid leukemia with clofarabine, cytarabine and ATG

Bone Marrow Transplantation volume 44, pages 13–17 (2009)Cite this article

Abstract

The application of myeloablative Allo-SCT is limited by its associated morbidity and mortality. Reduced-intensity conditioning regimens attempt to diminish these, but are associated with a higher risk of disease relapse. Given the evidence of activity of clofarabine and cytarabine in myelodysplastic syndrome/acute myeloid leukemia (MDS/AML), we explored a novel reduced-intensity conditioning regimen based on this backbone. Patients received clofarabine 40 mg/m2 i.v. on days –6 to –2, cytarabine 1 g/m2 i.v. on days –6 to –2 and anti-thymocyte globulin (ATG) 1 mg/kg on day –4 and 2.5 mg/kg × 2 days on days –3 and –2. Seven patients were enrolled. Their median age was 54 years; three were with MDS and four with AML. The median duration of neutropenia was 14 days and that of thrombocytopenia was 22 days. Toxicities included hand–foot syndrome (57% grade 2), elevated alanine aminotransferase (ALT) (57% grade 3), elevated aspartate aminotransferase (AST) (86% grade 3) and hyperbilirubinemia (29% grade 3–5). No acute GVHD was observed. Enrollment to the trial was halted after three of the first seven patients expired on days +15, +26 and +32. Three of the four surviving patients have relapsed with a median TTP of 152 days. This regimen was not sufficiently immunosuppressive to ensure engraftment, and was associated with substantial morbidity and mortality.

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  1. Division of Oncology, Section of Leukemia and Bone Marrow Transplantation, Washington University School of Medicine, Saint Louis, MO, USA

    M G Martin, G L Uy, E Procknow, K Stockerl-Goldstein, A Cashen, P Westervelt, C N Abboud, K Augustin, J Luo, J F DiPersio & R Vij

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  1. M G Martin
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  2. G L Uy
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  3. E Procknow
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  4. K Stockerl-Goldstein
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Correspondence to M G Martin.

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Martin, M., Uy, G., Procknow, E. et al. Allo-SCT conditioning for myelodysplastic syndrome and acute myeloid leukemia with clofarabine, cytarabine and ATG. Bone Marrow Transplant 44, 13–17 (2009). https://doi.org/10.1038/bmt.2008.423

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  • DOI: https://doi.org/10.1038/bmt.2008.423

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