Cladribine in the Treatment of Acute Myeloid Leukemia: A Single-Institution Experience

• Published in: Clinical lymphoma & myeloma 2009-08, Vol.9 (4), p.298-301
• Main Authors: Martin, Mike G., Welch, John S., Augustin, Kristan, Hladnik, Lindsay, DiPersio, John F., Abboud, Camille N.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cladribine - administration & dosage; Cladribine - adverse effects; Cladribine - therapeutic use; Cytarabine; Female; Granulocyte colony-stimulating factor; Humans; Induction therapy; Injections, Subcutaneous; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - drug therapy; Male; Middle Aged; Mitoxantrone; Recurrence; Retrospective Studies; Salvage Therapy; Treatment Outcome; Young Adult
• ISSN: 1557-9190; 1938-0712
• DOI: 10.3816/CLM.2009.n.058

Despite advances in novel therapeutics, supportive care, and postremission therapy, the outcome of high-risk and elderly patients as well as those with relapsed/refractory acute myeloid leukemia (AML) remains poor. There is likely still room for improvement through optimizing conventional chemotherapy. Through a pharmacy database search we identified all patients with AML treated at Washington University with cladribine-based regimens. Twenty-four patients were identified that were treated with 2 cladribine-based regimens: CLAG (cladribine [5 mg/m2 days 1-5], cytarabine [2 g/m2 days 1-5] and granulocyte colony-stimulating factor [G-CSF; 300 μg subcutaneously (s.c.) days 0-5]) and CLAM (cladribine [5 mg/m2 days 1-5], cytarabine [2 g/m2 days 1-5], G-CSF [300 mg s.c. days 0-5] and mitoxantrone [10 mg/m2 days 1-3]). Complete responses were achieved in 53% of patients given induction chemotherapy and 44% of those given salvage chemotherapy. The regimens were well tolerated with minimal extramedullary toxicity. These data suggest that cladrabine-based regimens should be further explored in both the salvage and first-line setting and might offer an attractive backbone on which to add novel therapies.