Impact of cladribine, cytarabine, and G-CSF (CLAG) as a bridging therapy prior to allogeneic hematopoietic stem cell transplantation in relapsed or refractory acute myeloid leukemia

Tong Cui; Huiyu Li; Shiyuan Zhou; Jing Li; Qian Zhu; Wenjuan Zhu; Zaixiang Tang; Xiao Ma; Huiying Qiu; Depei Wu; Xiaojin Wu

doi:10.1007/s00277-024-05791-z

Impact of cladribine, cytarabine, and G-CSF (CLAG) as a bridging therapy prior to allogeneic hematopoietic stem cell transplantation in relapsed or refractory acute myeloid leukemia

Ann Hematol. 2024 May 17. doi: 10.1007/s00277-024-05791-z. Online ahead of print.

Authors

Tong Cui^#^{1

2

3}, Huiyu Li^#^{1

2

3}, Shiyuan Zhou^{1

2

3}, Jing Li^{1

2

3}, Qian Zhu⁴, Wenjuan Zhu^{1

2

3}, Zaixiang Tang⁵, Xiao Ma^{1

2

3}, Huiying Qiu^{1

2

3}, Depei Wu^{6

7

8}, Xiaojin Wu^{9

10

11}

Affiliations

¹ Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
² National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China.
³ Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
⁴ Soochow Hopes Hematonosis Hospital, Suzhou, China.
⁵ Department of Epidemiology and Statistics, School of Public Health, Faculty of Medicine, Soochow University, Suzhou, China.
⁶ Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China. wudepei@suda.edu.cn.
⁷ National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China. wudepei@suda.edu.cn.
⁸ Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China. wudepei@suda.edu.cn.
⁹ Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China. wuxiaojin@suda.edu.cn.
¹⁰ National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China. wuxiaojin@suda.edu.cn.
¹¹ Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China. wuxiaojin@suda.edu.cn.

^# Contributed equally.

PMID: 38758360
DOI: 10.1007/s00277-024-05791-z

Abstract

The combination of cladribine, cytarabine, and G-CSF (CLAG) has exhibited robust synergistic anti-leukemia activity as an induction therapy (IT) in acute myeloid leukemia (AML). However, the impact of CLAG as a bridging therapy (BT) administered between IT and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with relapsed or refractory (R/R) AML remains uncertain. In this retrospective study, we examined the efficacy of CLAG as a transitional strategy prior to allo-HSCT in R/R AML. We included 234 patients with R/R AML who received the modified busulfan plus cyclophosphamide conditioning regimen for allo-HSCT in our center during the past 6 years, performed a propensity-score matching analysis, partitioned them into four distinct cohorts, and further integrated them into the CLAG group and non-CLAG group based on response to IT and utilization of CLAG. Our cohorts encompassed 12 patients in Cohort A (modified composite complete remission (mCRc) after IT, CLAG), 31 in Cohort B (mCRc after IT, non-CLAG), 35 in Cohort C (non-complete remission (non-CR) after IT, CLAG), and 80 in Cohort D (non-CR after IT, non-CLAG). Intriguingly, among patients with non-CR status, the administration of CLAG correlated with a notably statistically diminished risk of relapse and improved survival at 2-year follow-up (Cohort C vs. Cohort D). Employing CLAG as a BT prior to allo-HSCT demonstrates substantial effectiveness, a relative degree of safety, and manageable toxicity in selected R/R AML cases.

Keywords: Allogeneic hematopoietic stem cell transplantation; Bridging therapy; Cladribine; Relapsed or refractory acute myeloid leukemia.

Abstract

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