Phase II study of clofarabine in pediatric patients with refractory or relapsed acute lymphoblastic leukemia

Sima Jeha, Paul S. Gaynon, Bassem I. Razzouk, Janet Franklin, Richard Kadota, Violet Shen, Lori Luchtman-Jones, Michael Rytting, Lisa R. Bomgaars, Susan Rheingold, Kim Ritchey, Edythe Albano, Robert J. Arceci, Stewart Goldman, Timothy Griffin, Arnold Altman, Bruce Gordon, Laurel Steinherz, Steven Weitman, Peter Steinherz

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Abstract

Purpose: To evaluate the efficacy and safety of clofarabine, a novel deoxyadenosine analog, in pediatric patients with refractory or relapsed acute lymphoblastic leukemia (ALL). Patients and Methods: In a phase II, open-label, multicenter study, 61 pediatric patients with refractory or relapsed ALL received clofarabine 52 mg/m2 intravenously over 2 hours daily for 5 days, every 2 to 6 weeks. The median age was 12 years (range, 1 to 20 years), and the median number of prior regimens was three (range, two to six regimens). Results: The response rate was 30%, consisting of seven complete remissions (CR), five CRs without platelet recovery (CRp), and six partial remissions. Remissions were durable enough to allow patients to proceed to hematopoietic stem-cell transplantation (HSCT) after clofarabine. Median CR duration in patients who did not receive HSCT was 6 weeks, with four patients maintaining CR or CRp for 8 weeks or more (8+, 12, 37+, and 48 weeks) on clofarabine therapy alone. The most common adverse events of grade ≥ 3 were febrile neutropenia, anorexia, hypotension, and nausea. Conclusion: Clofarabine is active as a single agent in pediatric patients with multiple relapsed or refractory ALL. The toxicity profile is as expected in this heavily pretreated patient population. Studies exploring rational combinations of clofarabine with other agents are ongoing in an effort to maximize clinical benefit.

Original languageEnglish (US)
Pages (from-to)1917-1923
Number of pages7
JournalJournal of Clinical Oncology
Volume24
Issue number12
DOIs
StatePublished - Apr 20 2006

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Hematopoietic Stem Cell Transplantation
Febrile Neutropenia
clofarabine
Anorexia
Hypotension
Nausea
Multicenter Studies
Blood Platelets
Safety
Population

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Jeha, S., Gaynon, P. S., Razzouk, B. I., Franklin, J., Kadota, R., Shen, V., ... Steinherz, P. (2006). Phase II study of clofarabine in pediatric patients with refractory or relapsed acute lymphoblastic leukemia. Journal of Clinical Oncology, 24(12), 1917-1923. https://doi.org/10.1200/JCO.2005.03.8554

Phase II study of clofarabine in pediatric patients with refractory or relapsed acute lymphoblastic leukemia. / Jeha, Sima; Gaynon, Paul S.; Razzouk, Bassem I.; Franklin, Janet; Kadota, Richard; Shen, Violet; Luchtman-Jones, Lori; Rytting, Michael; Bomgaars, Lisa R.; Rheingold, Susan; Ritchey, Kim; Albano, Edythe; Arceci, Robert J.; Goldman, Stewart; Griffin, Timothy; Altman, Arnold; Gordon, Bruce; Steinherz, Laurel; Weitman, Steven; Steinherz, Peter.

In: Journal of Clinical Oncology, Vol. 24, No. 12, 20.04.2006, p. 1917-1923.

Research output: Contribution to journalArticle

Jeha, S, Gaynon, PS, Razzouk, BI, Franklin, J, Kadota, R, Shen, V, Luchtman-Jones, L, Rytting, M, Bomgaars, LR, Rheingold, S, Ritchey, K, Albano, E, Arceci, RJ, Goldman, S, Griffin, T, Altman, A, Gordon, B, Steinherz, L, Weitman, S & Steinherz, P 2006, 'Phase II study of clofarabine in pediatric patients with refractory or relapsed acute lymphoblastic leukemia', Journal of Clinical Oncology, vol. 24, no. 12, pp. 1917-1923. https://doi.org/10.1200/JCO.2005.03.8554
Jeha, Sima ; Gaynon, Paul S. ; Razzouk, Bassem I. ; Franklin, Janet ; Kadota, Richard ; Shen, Violet ; Luchtman-Jones, Lori ; Rytting, Michael ; Bomgaars, Lisa R. ; Rheingold, Susan ; Ritchey, Kim ; Albano, Edythe ; Arceci, Robert J. ; Goldman, Stewart ; Griffin, Timothy ; Altman, Arnold ; Gordon, Bruce ; Steinherz, Laurel ; Weitman, Steven ; Steinherz, Peter. / Phase II study of clofarabine in pediatric patients with refractory or relapsed acute lymphoblastic leukemia. In: Journal of Clinical Oncology. 2006 ; Vol. 24, No. 12. pp. 1917-1923.
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AU - Gaynon, Paul S.

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AU - Shen, Violet

AU - Luchtman-Jones, Lori

AU - Rytting, Michael

AU - Bomgaars, Lisa R.

AU - Rheingold, Susan

AU - Ritchey, Kim

AU - Albano, Edythe

AU - Arceci, Robert J.

AU - Goldman, Stewart

AU - Griffin, Timothy

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N2 - Purpose: To evaluate the efficacy and safety of clofarabine, a novel deoxyadenosine analog, in pediatric patients with refractory or relapsed acute lymphoblastic leukemia (ALL). Patients and Methods: In a phase II, open-label, multicenter study, 61 pediatric patients with refractory or relapsed ALL received clofarabine 52 mg/m2 intravenously over 2 hours daily for 5 days, every 2 to 6 weeks. The median age was 12 years (range, 1 to 20 years), and the median number of prior regimens was three (range, two to six regimens). Results: The response rate was 30%, consisting of seven complete remissions (CR), five CRs without platelet recovery (CRp), and six partial remissions. Remissions were durable enough to allow patients to proceed to hematopoietic stem-cell transplantation (HSCT) after clofarabine. Median CR duration in patients who did not receive HSCT was 6 weeks, with four patients maintaining CR or CRp for 8 weeks or more (8+, 12, 37+, and 48 weeks) on clofarabine therapy alone. The most common adverse events of grade ≥ 3 were febrile neutropenia, anorexia, hypotension, and nausea. Conclusion: Clofarabine is active as a single agent in pediatric patients with multiple relapsed or refractory ALL. The toxicity profile is as expected in this heavily pretreated patient population. Studies exploring rational combinations of clofarabine with other agents are ongoing in an effort to maximize clinical benefit.

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