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A multicenter trial of myeloablative clofarabine and busulfan conditioning for relapsed or primary induction failure AML not in remission at the time of allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2017 Jan;52(1):59-65 PMID: 27427921 PMCID: PMC5215562

Pubmed ID



Allogeneic hematopoietic cell transplantation (HCT) may produce long-term survival in AML after relapse or primary induction failure (PIF). However, outcomes of HCT performed for AML not in remission are historically poor given high relapse rates and transplant-related mortality. Preliminary studies suggest conditioning with clofarabine and myeloablative busulfan (CloBu4) may exert significant anti-leukemic effects without excessive toxicity in refractory hematologic malignancies. A prospective multicenter phase II trial was conducted to determine the efficacy of CloBu4 for patients proceeding directly to HCT with AML not in remission. Seventy-one patients (median age: 56 years) received CloBu4. At day 30 after HCT, 90% achieved morphologic remission. The incidence of non-relapse mortality and relapse at 2 years was 25% and 55%, respectively. The 2-year overall survival (OS) and event-free survival (EFS) were 26% and 20%, respectively. Patients entering HCT in PIF had significantly greater EFS than those in relapse (34% vs 8%; P<0.01). Multivariate analysis comparing CloBu4 with a contemporaneous cohort (Center for International Blood and Marrow Transplantation Research) of AML not in remission receiving other myeloablative conditioning (n=105) demonstrated similar OS (HR: 1.33, 95% confidence interval: 0.92-1.92; P=0.12). HCT with myeloablative CloBu4 is associated with high early response rates and may produce durable remissions in select patients with AML not in remission.

Author List

Magenau J, Westervelt P, Khaled S, McGuirk J, Hari P, Eapen M, Becker PS, Parkin B, Braun T, Logan B, Wang H, Jagasia M, Rowley SD, Kim DD, Schechter T, Frey N, Scott B, Churay T, Lieland S, Forman S, Mineishi S


Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin
Brent R. Logan PhD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin


2-s2.0-84978696407   4 Citations

MESH terms used to index this publication - Major topics in bold

Adenine Nucleotides
Disease-Free Survival
Hematopoietic Stem Cell Transplantation
Induction Chemotherapy
Leukemia, Myeloid, Acute
Middle Aged
Survival Rate
Transplantation Conditioning
jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6