Treatment of High-Risk Acute Myeloid Leukemia With Cladribine, Cytarabine, Mitoxantrone, and Granulocyte Colony-Stimulating Factor Then Subsequent Bridging to Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation: A Case Series

This report preliminarily evaluates the efficacy and safety of cladribine, cytarabine, mitoxantrone, and granulocyte colony-stimulating factor (CLAG-M) as bridging therapy to myeloablative allogeneic hematopoietic cell transplantation (allo-HCT) in the treatment of patients with refractory or relapsed acute myeloid leukemia. Five patients with high-risk refractory or relapsed acute myeloid leukemia received the CLAG-M regimen and subsequent bridging to myeloablative allo-HCT between December 2014 and August 2015 in our hospital. The CLAG-M regimen consisted of cladribine 5 mg/m2 on days 1-5, cytarabine 2 g/m2 on days 1-5, granulocyte-colony stimulating factor 300 μg on days 0-5, and mitoxantrone 10 mg on days 1-5. At 3-8 days after CLAG-M, patients accepted myeloablative allo-HCTs. One patient (20%) died before stem cell infusion from treatment toxicity. Four patients (80%) underwent allo-HCT from matched sibling or haploidentical donors and all achieved complete remission. The median follow-up was 25 months (range, 22-31). Three patients (60%) survived, and 1 patient (20%) died owing to relapse 22 months after transplantation. Two patients (40%) among survivors achieved 2-year disease-free survival. The other survivor, who had survived for 31 months, experienced isolated central nervous system relapse 4 months after transplantation, but was cured by intrathecal injecting and cranial radiotherapy. CLAG-M bridging to myeloablative allo-HCT might be a well-tolerated and highly effective salvage regimen in patients with poor risk refractory or relapsed acute myeloid leukemia.