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Prepublished online as a Blood First Edition Paper on June 5, 2003; DOI 10.1182/blood-2003-03-0925.

Submitted April 1, 2003
Accepted May 24, 2003
Phase II clinical and pharmacology study of clofarabine in patients with refractory or relapsed acute leukemia
Hagop M Kantarjian*, Varsha Gandhi, Jorge Cortes, Srdan Verstovsek, Min Du, Guillermo Garcia-Manero, Francis Giles, Stefan Faderl, Susan O'Brien, Sima Jeha, Jan Davis, Zeev Shaked, Adam Craig, Michael Keating, William Plunkett, and Emil J Freireich
Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
ILEX Company, San Antonio, TX, USA
Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
* Corresponding author; email: hkantarj{at}mdanderson.org.
In a phase II study, 62 patients with relapsed and refractory acute myeloid leukemia (AML; N=31), myelodysplastic syndrome (MDS; N=8), chronic myeloid leukemia in blastic phase (CMLBP; N=11) and acute lymphocytic leukemia (ALL; N=12) received clofarabine 40 mg/m2 IV over 1 hour daily x 5, every 3 to 6 weeks. Twenty patients (32%) achieved complete response (CR), 1 had a partial response (PR), and 9 (15%) had CR but without platelet recovery (CR-p), for an overall response rate of 48%. In AML, responses were noted in 2/11 patients (18%) in first salvage with short first CR ( 12 months), in 7/8 (87%) patients with longer first CR, and in 8/12 patients (67%) in second or subsequent salvage. Responses were observed in 4/8 patients with high-risk MDS (50%), in 7/11 (64%) with CML-BP, and in 2/12 (17%) with ALL. Severe reversible liver dysfunction was noted in 15% to 25%. After the first clofarabine infusion, responders accumulated more clofarabine triphosphate in blasts compared to non-responders (median 18 vs 10 µM; p=0.03). This increased only in responders (median, 1.8-fold; p=0.008) after the second clofarabine infusion. In summary, clofarabine is active in acute leukemias and MDS; cellular pharmacokinetics may have prognostic significance.

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