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Clofarabine and CY do not yield reliable engraftment of hematopoietic stem cells

Bone Marrow Transplantation volume 47, pages 1134–1135 (2012)Cite this article

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Purine analogs, particularly fludarabine, have recognized immunosuppressive properties, making them useful for conditioning patients for engraftment with allogeneic hematopoietic cells. Fludarabine is immunosuppressive enough that its non-transplant use poses significant risks of transfusion-related GVHD after transfusion of unirradiated blood products.1 Clofarabine has attractive anti-leukemic activity2, 3 and its chemical structure suggests immunosuppressive properties similar to fludarabine.4 Accordingly, we chose this purine analog to replace fludarabine in combination with CY5 as non-myeloablative pre-transplant conditioning.

In order to establish the relative myelosuppressive properties of the Clo-CY regimen vs Flu-CY, we compared the time taken in achieving ANC>500 in two groups failing to achieve at least 10% donor engraftment by day 12–18 (our initial assessment of chimerism). Six such patients treated with Flu-CY and similar immunoprophylaxis (one had been excluded from the above analysis because of having received >5 × 106 donor CD34 cells/kg body weight) achieved ANC>500 at days 8–10 (mean 9 days). Those five patients not engrafting stably after Clo-CY recovered to ANC>500 at 8–24 days (mean day 17 –one, in fact, expired without recovery of neutrophils on day 18). Although these groups were not statistically different in time taken for neutrophil recovery (P=0.092—Mann–Whitney test), it seems safe to conclude that the Clo-CY regimen is at least as myelosuppressive as Flu-CY.

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  1. Department of Medicine, Hematology/Oncology Division, Penn State College of Medicine, Hershey, PA, USA

    J Karch, J Zhu, W C Ehmann & D Claxton

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  1. J Karch
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  2. J Zhu
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  3. W C Ehmann
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  4. D Claxton
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Correspondence to D Claxton.

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Karch, J., Zhu, J., Ehmann, W. et al. Clofarabine and CY do not yield reliable engraftment of hematopoietic stem cells. Bone Marrow Transplant 47, 1134–1135 (2012). https://doi.org/10.1038/bmt.2011.224

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