Salvage chemotherapy regimens for acute myeloid leukemia: Is one better? Efficacy comparison between CLAG and MEC regimens

Price, Samantha; Lancet, Jeffrey E.; George, Timothy J.; Wetzstein, Gene A.; List, Alan F.; Ho, Viet Q.; Fernandez, Hugo F.; Pinilla‐Ibarz, Javier; Komrokji, Rami S.

doi:10.1016/j.leukres.2010.09.002

Cited by 68 publications

(58 citation statements)

References 9 publications

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“…122,[219][220][221][222][223][224][225][226] Enrollment in a clinical trial should therefore be the priority for such patients whenever possible. Table 8 provides recommendations for salvage regimens in patients considered fit for intensive therapy.…”

Section: Salvage Treatmentmentioning

confidence: 99%

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Döhner

Estey

Grimwade

et al. 2017

Blood

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5,387

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The first edition of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults, published in 2010, has found broad acceptance by physicians and investigators caring for patients with AML. Recent advances, for example, in the discovery of the genomic landscape of the disease, in the development of assays for genetic testing and for detecting minimal residual disease (MRD), as well as in the development of novel antileukemic agents, prompted an international panel to provide updated evidence- and expert opinion-based recommendations. The recommendations include a revised version of the ELN genetic categories, a proposal for a response category based on MRD status, and criteria for progressive disease

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Section: Salvage Treatmentmentioning

confidence: 99%

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Döhner

Estey

Grimwade

et al. 2017

Blood

4,685

5,387

View full text Add to dashboard Cite

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“…Another phase I study performed by Walker et al [18] used a CLAG regimen as a treatment for R/R AML patients, and they obtained a median OS of 175 days (95% CI 16.24–333.76). In research comparing CLAG and MEC in R/R AML patients, CLAG achieved a median OS of 7.3 months, which is longer than that of MEC therapy [20]. All the above studies demonstrate that CLAG contributes to prolonged survival in R/R AML patients.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Efficacy and Prognostic Factors of CLAG Treatment in Chinese Patients with Refractory or Relapsed Acute Myeloid Leukemia

Wang

Tian

et al. 2018

Acta Haematol

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Background/Aims: The aim of this work was to investigate the efficacy and predictive factors of CLAG treatment in refractory or relapsed (R/R) acute myeloid leukemia (AML) patients. Methods: Sixty-seven R/R AML patients were enrolled in this prospective cohort study and treated by a CLAG regimen: 5 mg/m²/day cladribine (days 1–5), 2 g/m²/day cytarabine (days 1–5), and 300 μg/day filgrastim (days 0–5). The median follow-up duration was 10 months. Results: A total of 57 out of 67 patients were evaluable for remission after CLAG therapy, of whom 57.9% achieved a complete remission (CR) and the overall remission rate was 77.2%. The median overall survival (OS) was 10.0 months, with a 1-year OS of 40.3 ± 6.0% and 3-year OS of 16.7 ± 5.7%. CR at first induction after the initial diagnosis was associated with a favorable CR. Age above 60 years, high risk stratification, second or higher salvage therapy, and bone marrow (BM) blasts ≥42.1% were correlated with an unfavorable CR. Secondary disease, age ≥60 years, high risk stratification, and second or higher salvage therapy were associated with worse OS. Patients developed thrombocytopenia (41, 61%), febrile neutropenia (37, 55%), leukopenia (33, 49%), neutropenia (18, 27%), and anemia (9, 13%). Conclusion: CLAG was effective and well tolerated for R/R AML. BM blasts ≥42.1%, age ≥60 years, high risk stratification, and second or higher salvage therapy were independent factors for a poor prognosis.

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“…12 Similarly, poor long-term outcomes have been reported from a retrospective comparison of two alternative salvage chemotherapies. Price et al 31 reported OS at 2 years of 22% and 12%, respectively, for patients with r/r AML after chemotherapy combinations containing cladribine, cytarabine and granulocyte colony-stimulating factor or etoposide, cytarabine and mitoxantrone. When compared with historical data, we found a trend toward better OS of patients with relapsed AML treated within the BRIDGE trial compared with patients treated within the upfront AML 2003 trial of Study Alliance Leukemia (SAL).…”

Section: Discussionmentioning

confidence: 99%

Clofarabine salvage therapy before allogeneic hematopoietic stem cell transplantation in patients with relapsed or refractory AML: results of the BRIDGE trial

et al. 2015

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In patients with relapsed or refractory (r/r) acute myeloid leukemia (AML), long-term disease control can only be achieved by allogeneic hematopoietic stem cell transplantation (HSCT). We studied the safety and efficacy of clofarabine-based salvage therapy. The study was designed as phase II, multicenter, intent-to-transplant (ITT) study. A total of 84 patients with r/r AML were enrolled. All patients received at least one cycle of CLARA (clofarabine 30 mg/m(2) and cytarabine 1 g/m(2), days 1-5). Chemo-responsive patients with a donor received HSCT in aplasia after first CLARA. Generally, HSCT was performed as soon as possible. The conditioning regimen consisted of clofarabine (4 × 30 mg/m(2)) and melphalan (140 mg/m(2)). The median patient age was 61 years (range 40-75). On day 15 after start of CLARA, 26% of patients were in a morphologically leukemia-free state and 79% exposed a reduction in bone marrow blasts. Overall, 67% of the patients received HSCT within the trial. The primary end point, defined as complete remission after HSCT, was achieved by 60% of the patients. According to the ITT, overall survival at 2 years was 43% (95% confidence interval (CI), 32-54%). The 2-year disease-free survival for transplanted patients was 52% (95% CI, 40-69%). Clofarabine-based salvage therapy combined with allogeneic HSCT in aplasia shows promising results in patients with r/r AML.

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Salvage chemotherapy regimens for acute myeloid leukemia: Is one better? Efficacy comparison between CLAG and MEC regimens

Cited by 68 publications

References 9 publications

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel

Analysis of Efficacy and Prognostic Factors of CLAG Treatment in Chinese Patients with Refractory or Relapsed Acute Myeloid Leukemia

Clofarabine salvage therapy before allogeneic hematopoietic stem cell transplantation in patients with relapsed or refractory AML: results of the BRIDGE trial

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