Oral clofarabine in the treatment of patients with higher-risk myelodysplastic syndrome.

Abstract

PURPOSE:

Efficacy and toxicity profile of orally administered clofarabine were evaluated in patients with higher-risk myelodysplastic syndrome (MDS).

PATIENTS AND METHODS:

Thirty-two patients were treated, of whom 22 had intermediate-2 or high-risk disease (International Prognostic Scoring System). Median age was 70 years (range, 53 to 86), nine patients had secondary MDS, and 20 patients experienced prior therapy failure with hypomethylating agents. Three doses of clofarabine were evaluated: 40 mg/m(2), 30 mg/m(2), and 20 mg/m(2) daily for 5 days. Courses were repeated every 4 to 8 weeks.

RESULTS:

Eight patients (25%) achieved complete remission (CR), three had (9%) hematologic improvement (HI), and three had (9%) clinical benefit (CB; overall response rate, 43%). Responses in patients who experience treatment failure with hypomethylating agents included CR in two (10%), HI in two (10%), and CB in two patients (10%). No patients died within 6 weeks of induction. Renal failure occurred in four patients in the context of myelosuppression-associated infectious complications. Common adverse events were gastrointestinal and hepatic. Myelosuppression was common, but prolonged myelosuppression (> 42 days) was rare. The toxicity profile was better with lower doses of clofarabine, whereas response rates did not differ significantly.

CONCLUSION:

Oral clofarabine has achieved a response rate of 43% in patients with higher-risk MDS. The optimal dose and schedule and the appropriate patient population for such therapy remain to be further defined.

• Authors: Stefan Faderl, Guillermo Garcia-Manero, Zeev Estrov, Farhad Ravandi, Gautam Borthakur, Jorge E Cortes, Susan O'Brien, Varsha Gandhi, William Plunkett, Anna Byrd, Monica Kwari, Hagop M Kantarjian
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 16 Pg. 2755-60 (Jun 01 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20421540 (Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adenine Nucleotides
• Antineoplastic Agents
• Arabinonucleosides
• Clofarabine

Topics

• Adenine Nucleotides (administration & dosage, adverse effects)
• Administration, Oral
• Age Factors
• Aged
• Aged, 80 and over
• Antineoplastic Agents (administration & dosage, adverse effects)
• Arabinonucleosides (administration & dosage, adverse effects)
• Clofarabine
• Disease-Free Survival
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Maximum Tolerated Dose
• Middle Aged
• Myelodysplastic Syndromes (diagnosis, drug therapy, mortality)
• Probability
• Prognosis
• Prospective Studies
• Risk Assessment
• Survival Analysis
• Time Factors
• Treatment Outcome