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Conference Paper: Clofarabine and high-dose cytarabine arabinoside (clara) for primary refractory or relapsed acute myeloid leukaemia: a prospective follow-up study of 60 patients
Title | Clofarabine and high-dose cytarabine arabinoside (clara) for primary refractory or relapsed acute myeloid leukaemia: a prospective follow-up study of 60 patients |
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Authors | |
Keywords | Acute myeloid leukemia Clofarabine |
Issue Date | 2015 |
Citation | The 20th Congress of the European Haematology Association (EHA 2015), Vienna, Austria, 11-14 June 2015. How to Cite? |
Abstract | BACKGROUND: Relapsed or refractory acute myeloid leukaemia (AML) is associated with a poor prognosis with a remission rate ranging between 10 to 40 percent with conventional salvage regimens. Clofarabine was designed to incorporate the anti-leukaemic properties of fludarabine and cladribine, both of which are active against AML. AIMS: The aim of this study was to prospectively evaluate the efficacy and tolerability of the salvage regimen combining clofarabine and high-dose cytarabine in patients with primary refractory or relapsed AML in the real-world scenario. METHODS: Patients with primary refractory or relapsed AML were prospectively recruited between 1 June 2009 and 31 December 2013. All data was censored on 30 June 2014. Patients were treated with Clofarabine at 40mg/m2/day from day 1 to day 5) in combination with cytarabine arabinoside (AraC) at 2g/m2/day from day 1 to day 5 (CLARA). Clinicopathologic features, treatment response and survivals were determined. Prognostic factors for response and survivals were determined using logistic regression and cox regression. RESULTS: 60 patients with primary refractory or relapsed AML were recruited (primary refractory,N=18; first relapse,N=31, second relapse,N=10, third relapse,N=1). 29 men and 31 women with a median age of 48.5 (range: 18-66) were recruited. They received a median of 2 (range:1-5) prior induction/re-induction regimens for AML. 36 patients (40%) had normal karyotype at diagnosis while 24 patients (60%) had abnormal karyotype. 8 patients had fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) and 5 patients had mutated nucleophosmin 1 (NPM1). 8 patients achieved complete remission (CR) and 25 patients achieved a complete remission with incomplete haematopoietic recovery (CRi) making the CR/CRi rate of 55%. 17 patients progressed after initial remission. 15 patients (25%) underwent allogeneic haematopoietic stem cell transplantation (HSCT) after remission. Grade 3/4 haematological toxicity was seen in all 60 patients. Febrile neutropenia occurred in 24 patients (40%) and grade 3/4 hepatotoxicity was seen in 5 patients (8%). With a median follow-up of 6.5 months (range: 1-43), the median overall survival was 8 months (95% confidence interval:5.04-10.96). The overall survival at 12 and 24 months was 38.9% and 29.7% respectively. Patients who were successfully bridged to allogeneic HSCT had a significantly better overall survival (P<0.001). The overall survival at 36 months in patients who underwent HSCT was 62.2%. The median progression-free survival following CLARA was 6 months. SUMMARY: Clofarabine in combination with high-dose cytarabine was effective in inducing a response in a significant proportion of patients with heavily-pretreated primary refractory or relapsed AML. Successful bridge to subsequent curative allogeneic HSCT was the major determinant of overall survival. |
Description | E-poster: no. E929 |
Persistent Identifier | http://hdl.handle.net/10722/210627 |
DC Field | Value | Language |
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dc.contributor.author | Singh, GHH | - |
dc.contributor.author | Chan, TSY | - |
dc.contributor.author | Hwang, YYG | - |
dc.contributor.author | Leung, AYH | - |
dc.contributor.author | Tse, EWC | - |
dc.contributor.author | Kwong, YL | - |
dc.date.accessioned | 2015-06-22T04:35:08Z | - |
dc.date.available | 2015-06-22T04:35:08Z | - |
dc.date.issued | 2015 | - |
dc.identifier.citation | The 20th Congress of the European Haematology Association (EHA 2015), Vienna, Austria, 11-14 June 2015. | - |
dc.identifier.uri | http://hdl.handle.net/10722/210627 | - |
dc.description | E-poster: no. E929 | - |
dc.description.abstract | BACKGROUND: Relapsed or refractory acute myeloid leukaemia (AML) is associated with a poor prognosis with a remission rate ranging between 10 to 40 percent with conventional salvage regimens. Clofarabine was designed to incorporate the anti-leukaemic properties of fludarabine and cladribine, both of which are active against AML. AIMS: The aim of this study was to prospectively evaluate the efficacy and tolerability of the salvage regimen combining clofarabine and high-dose cytarabine in patients with primary refractory or relapsed AML in the real-world scenario. METHODS: Patients with primary refractory or relapsed AML were prospectively recruited between 1 June 2009 and 31 December 2013. All data was censored on 30 June 2014. Patients were treated with Clofarabine at 40mg/m2/day from day 1 to day 5) in combination with cytarabine arabinoside (AraC) at 2g/m2/day from day 1 to day 5 (CLARA). Clinicopathologic features, treatment response and survivals were determined. Prognostic factors for response and survivals were determined using logistic regression and cox regression. RESULTS: 60 patients with primary refractory or relapsed AML were recruited (primary refractory,N=18; first relapse,N=31, second relapse,N=10, third relapse,N=1). 29 men and 31 women with a median age of 48.5 (range: 18-66) were recruited. They received a median of 2 (range:1-5) prior induction/re-induction regimens for AML. 36 patients (40%) had normal karyotype at diagnosis while 24 patients (60%) had abnormal karyotype. 8 patients had fms-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) and 5 patients had mutated nucleophosmin 1 (NPM1). 8 patients achieved complete remission (CR) and 25 patients achieved a complete remission with incomplete haematopoietic recovery (CRi) making the CR/CRi rate of 55%. 17 patients progressed after initial remission. 15 patients (25%) underwent allogeneic haematopoietic stem cell transplantation (HSCT) after remission. Grade 3/4 haematological toxicity was seen in all 60 patients. Febrile neutropenia occurred in 24 patients (40%) and grade 3/4 hepatotoxicity was seen in 5 patients (8%). With a median follow-up of 6.5 months (range: 1-43), the median overall survival was 8 months (95% confidence interval:5.04-10.96). The overall survival at 12 and 24 months was 38.9% and 29.7% respectively. Patients who were successfully bridged to allogeneic HSCT had a significantly better overall survival (P<0.001). The overall survival at 36 months in patients who underwent HSCT was 62.2%. The median progression-free survival following CLARA was 6 months. SUMMARY: Clofarabine in combination with high-dose cytarabine was effective in inducing a response in a significant proportion of patients with heavily-pretreated primary refractory or relapsed AML. Successful bridge to subsequent curative allogeneic HSCT was the major determinant of overall survival. | - |
dc.language | eng | - |
dc.relation.ispartof | Congress of the European Haematology Association, EHA 2015 | - |
dc.subject | Acute myeloid leukemia | - |
dc.subject | Clofarabine | - |
dc.title | Clofarabine and high-dose cytarabine arabinoside (clara) for primary refractory or relapsed acute myeloid leukaemia: a prospective follow-up study of 60 patients | - |
dc.type | Conference_Paper | - |
dc.identifier.email | Singh, GHH: gillhsh@hku.hk | - |
dc.identifier.email | Hwang, YYG: yyhwang@hku.hk | - |
dc.identifier.email | Leung, AYH: ayhleung@hku.hk | - |
dc.identifier.email | Tse, EWC: ewctse@hku.hk | - |
dc.identifier.email | Kwong, YL: ylkwong@hkucc.hku.hk | - |
dc.identifier.authority | Singh, GHH=rp01914 | - |
dc.identifier.authority | Leung, AYH=rp00265 | - |
dc.identifier.authority | Tse, EWC=rp00471 | - |
dc.identifier.authority | Kwong, YL=rp00358 | - |
dc.identifier.hkuros | 244075 | - |