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Am J Hematol. 2009 Apr;84(4):228-30. doi: 10.1002/ajh.21365.

The use of higher dose clofarabine in adults with relapsed acute lymphoblastic leukemia.

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  • 1Department of Medicine, Hematology-Oncology, San Antonio Military Medical Center, San Antonio, Texas, USA.


The standard dose of clofarabine is 52 mg/m2 for pediatrics and 40 mg/m2 in adults. Clofarabine dosed at 52 mg/m2 was used in adult patients with refractory ALL to maximize response before allo-HSCT. All patients had a significant response to therapy. Published pharmacokinetic analysis revealed no difference in peak plasma or intracellular concentrations at clofarabine dosed above 40 mg/m2, yet inhibition of replication in leukemia cells was only sustained over 24 hr at 55 mg/m2. Despite this, there have been no reports of high dose clofarabine used in this setting. Our experience implies that there may be a niche role for clofarabine in reducing disease burden before allo-HSCT for adults with relapsed ALL.

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