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Randomized Controlled Trial
. 2008 Sep 1;112(5):1638-45.
doi: 10.1182/blood-2007-11-124602. Epub 2008 Jun 18.

A randomized study of clofarabine versus clofarabine plus low-dose cytarabine as front-line therapy for patients aged 60 years and older with acute myeloid leukemia and high-risk myelodysplastic syndrome

Stefan Faderl  1 , Farhad Ravandi, Xuelin Huang, Guillermo Garcia-Manero, Alessandra Ferrajoli, Zeev Estrov, Gautam Borthakur, Srdan Verstovsek, Deborah A Thomas, Monica Kwari, Hagop M Kantarjian
Affiliations
Randomized Controlled Trial

A randomized study of clofarabine versus clofarabine plus low-dose cytarabine as front-line therapy for patients aged 60 years and older with acute myeloid leukemia and high-risk myelodysplastic syndrome

Stefan Faderl et al. Blood. .

Abstract

We previously reported the feasibility of clofarabine and cytarabine combinations in AML. Questions remain as to (1) the therapeutic advantage of this combination and (2) the role of lower doses of clofarabine and cytarabine in older patients. We have conducted an adaptively randomized study of lower-dose clofarabine with or without low-dose cytarabine in previously untreated patients with AML aged 60 years and older. Patients received 30 mg/m(2) clofarabine intravenously daily for 5 days with or without 20 mg/m(2) cytarabine subcutaneously daily for 14 days as induction. Consolidation consisted of 3 days of clofarabine with or without 7 days of cytarabine. Seventy patients were enrolled. The median age was 71 years (range, 60-83 years). Sixteen patients received clofarabine and 54 the combination. Overall, 56% achieved complete remission (CR). CR rate was significantly higher with the combination (63% vs 31%; P = .025). Induction mortality was 19% with the combination versus 31% with clofarabine alone (P = .276). The combination showed better event-free survival (7.1 months vs 1.7 months; P = .04), but not overall survival (11.4 months vs 5.8 months; P = .1). Clofarabine plus low-dose cytarabine has a higher response rate than clofarabine alone with comparable toxicity. This trial is registered at www.clinicaltrials.gov as no. NCT00088218.

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Figures

Figure 1
Figure 1
Overall and event-free survival of all patients. (A) Overall survival. (B) Event-free survival.
Figure 2
Figure 2
Remission duration and survival of CR patients. (A) Remission duration. (B) Overall survival of complete responders.
See this image and copyright information in PMC

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