Reactions 1453 - 25 May 2013

SClofarabine

Myelosuppression, infectious complications andliver disorders in paediatric patients: 6 case reports

Four boys and two girls, aged 4 months to 5 years, wereidentified from a retrospective study after they developedmyelosuppression, infectious complications and liverdisorders while receiving clofarabine [routes and durations oftreatment to reaction onsets not stated]. One patient later died.

The patients, who had refractory high-risk Langerhans cellhistiocytosis (LCH), received 6–8 cycles of clofarabine20–35 mg/m2 for 3–5 days per cycle. The cycles wereadministered approximately every 4 weeks. All patientsdeveloped myelosuppression, including grade 4 neutropeniaand/or grade 3 febrile neutropenia requiring admission. Threepatients developed four episodes of bacteraemia due toEnterococcus, Staphylococcus epidermidis or Bacillus speciesand one patient experienced a dental abscess. One boydeveloped transient grade 2 liver enzyme elevation andgrade 4 direct hyperbilirubinaemia after cycles 1 and 2.

Five patients required transfusions of RBCs and plateletswith most clofarabine cycles, and four patients receivedfilgrastim to reduce the duration of neutropenia followingclofarabine administration. Subsequent cycles were startedafter absolute neutrophil count recovery in most cases.Myelosuppression was also managed with clofarabine dosereduction. One boy had persistently increased livertransaminase levels and hepatomegaly 1.5 years aftertreatment; liver biopsy showed stage 1 portal fibrosis[outcome not stated]. One girl later received palliative therapywith clofarabine after recurrence of LCH; she subsequentlydied of progressive disease.

Author comment: "[In this study] there were noclofarabine-related deaths, and the most common toxicitywas myelosuppression. . . The only lasting toxicity in thiscohort possibly attributable to clofarabine is stage 1 portalfibrosis in [one patient]."Abraham A, et al. Clofarabine salvage therapy for refractory high-risk langerhanscell histiocytosis. Pediatric Blood and Cancer 60: E19-E22, No. 6, Jun 2013.Available from: URL: http://dx.doi.org/10.1002/pbc.24436 - USA 803087344

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Reactions 25 May 2013 No. 14530114-9954/10/1453-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved