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Clinical Trials

A clofarabine-based bridging regimen in patients with relapsed ALL and persistent minimal residual disease (MRD)

Bone Marrow Transplantation volume 49, pages 440–442 (2014)Cite this article

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Abstract

In patients with relapsed ALL, minimal residual disease (MRD) identified prior to allogeneic hematopoietic cell transplantation (HCT) is a strong predictor of relapse. We report our experience using a combination of reduced-dosing clofarabine, CY and etoposide as a ‘bridge’ to HCT in eight patients with high risk or relapsed ALL and pre-HCT MRD. All patients had detectable MRD (>0.01%, flow cytometry) at the start of therapy with all eight achieving MRD reduction following one cycle. The regimen was well tolerated with seven grade 3/4 toxicities occurring among four of the eight patients. Five patients (62.5%) are alive, one died from relapse (12.5%) and two from transplant-related mortality (25%). The combination of reduced-dose clofarabine, CY and etoposide as bridging therapy appears to be well tolerated in patients with relapsed ALL and is effective in reducing pre-HCT MRD.

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Acknowledgements

Children’s Cancer Research Fund (MJB, MRV) and the University of Minnesota Pediatric Leukemia Program supported this work.

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Authors and Affiliations

  1. Department of Pediatrics, University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN, USA

    N Gossai

  2. Division of Pediatric Blood and Marrow Transplantation, University of Minnesota Amplatz Children’s Hospital, Minneapolis, MN, USA

    M R Verneris

  3. Division of Pediatric Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, CA, USA

    N A Karras

  4. Division of Pediatric Hematology-Oncology, Kaiser Permanente-Oakland, Santa Clara, CA, USA

    M F Gorman

  5. Division of Pediatric Hematology-Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA

    N J Patel

  6. Division of Pediatric Hematology-Oncology-BMT, Medical College of Wisconsin, Milwaukee, WI, USA

    M J Burke

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  1. N Gossai
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  4. M F Gorman
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  5. N J Patel
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  6. M J Burke
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Correspondence to M J Burke.

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Gossai, N., Verneris, M., Karras, N. et al. A clofarabine-based bridging regimen in patients with relapsed ALL and persistent minimal residual disease (MRD). Bone Marrow Transplant 49, 440–442 (2014). https://doi.org/10.1038/bmt.2013.195

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