Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Pharmacother. 2012 Jan;46(1):89-96. doi: 10.1345/aph.1Q295. Epub 2011 Dec 13.
To review the literature evaluating the efficacy and tolerability of clofarabine, a second-generation purine nucleoside analogue, for the treatment of previously untreated acute myeloid leukemia (AML) in older adults.
A literature search of the PubMed database (1972-October 2011) using the search terms clofarabine and acute myeloid leukemia was performed.
All relevant English-language articles were reviewed, and clinical trials with patients aged 50 years or older who were newly diagnosed with AML were included.
Two studies evaluating clofarabine as monotherapy and 2 studies evaluating clofarabine in combination with cytarabine were reviewed. Clofarabine demonstrated activity in older adults with previously untreated AML. Response rates and median overall survival (OS) for patients receiving clofarabine were similar to those reported for conventional intensive chemotherapy regimens. Responses to the 2 types of treatment remained similar in the presence of unfavorable prognostic factors, such as secondary AML or adverse cytogenetics. Although clofarabine was associated with a lower induction mortality rate versus intensive chemotherapy regimens, a significant percentage of patients experienced severe complications, including sepsis. Compared to single-agent clofarabine, response rates and median OS were higher for clofarabine combined with cytarabine.
Based on published data, adverse effect profiles, and cost, clofarabine may be an appropriate alternative to intensive chemotherapy regimens in certain subsets of older patients with newly diagnosed AML. These include patients with a baseline decreased performance status or history of cardiovascular disease who may not tolerate anthracyclines, which are typically a component of most intensive chemotherapy regimens. Additional randomized controlled trials are needed to directly compare the efficacy of clofarabine with that of intensive chemotherapy regimens and to evaluate the potential benefit of combining clofarabine with cytarabine.
回顾文献评估氯法拉滨的疗效和耐受性，第二代嘌呤核苷类似物，用于治疗未经治疗的老年急性髓系白血病（AML）。
使用搜索词氯法拉滨和急性髓系白血病在 PubMed 数据库（1972 年-2011 年 10 月）进行文献检索。
所有相关的英文文章进行了审查，并包括年龄在 50 岁或以上新诊断为 AML 的患者的临床试验。
评估氯法拉滨单药治疗的 2 项研究和评估氯法拉滨联合阿糖胞苷的 2 项研究进行了综述。氯法拉滨在未经治疗的老年 AML 患者中具有活性。接受氯法拉滨治疗的患者的反应率和中位总生存期（OS）与报告的常规强化化疗方案相似。在存在不良预后因素（如继发性 AML 或不良细胞遗传学）的情况下，两种治疗方法的反应仍然相似。虽然与强化化疗方案相比，氯法拉滨的诱导死亡率较低，但仍有相当比例的患者发生严重并发症，包括败血症。与单药氯法拉滨相比，氯法拉滨联合阿糖胞苷的反应率和中位 OS 更高。
根据已发表的数据，不良影响概况和成本，氯法拉滨可能是某些新诊断的 AML 老年患者替代强化化疗方案的合适选择。这些包括基线功能状态下降或有心血管疾病病史的患者，他们可能无法耐受大多数强化化疗方案中通常包含的蒽环类药物。需要进行更多的随机对照试验，以直接比较氯法拉滨与强化化疗方案的疗效，并评估氯法拉滨联合阿糖胞苷的潜在益处。
