{
  "abstract": "Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potentially curative option for patients with drug-refractory acute myeloid (AML) or acute lymphoblastic leukemia (ALL). Patients and Methods: We retrospectively analyzed 82 patients (median age 47.5 years, range 19–69; female:male ratio 1:1.28) with drug-refractory (R) or relapsed/refractory (RR) acute leukemia (AML n = 66; ALL n = 16) who were treated with clofarabine (10 mg/m2) and cyclophosphamide (200 mg/m2) days 1–4 (ClofCy) prior to HSCT. Results: ClofCy resulted in rapid cytoreduction (median time to granulocytes <0.5 × 109/L: 5 days). HSCT was performed in 62.2% (51/82) of our patients. Infections (18/31, 58%) were the main reason to withhold transplantation. HSCT and non-HSCT patients differed significantly regarding the median number of chemotherapies received prior to ClofCy (HSCT, median = two therapies; non-HSCT, median = three therapies; p = 0.027). Median overall survival (OS) was 0.31 years in all patients (5- and 10-year OS; 24% and 20%, respectively). HSCT patients had a median OS of 1.23 years (5- and 10-year OS; 38.4% and 31%, respectively) and those in the non-HSCT cohort a median OS of 0.11 years (5-year OS; 0%). Median OS and relapse-free survival (RFS) in the HSCT patient cohort were 1.04 and 0.9 years, respectively. Acute graft-versus-host disease (aGvHD) was associated with inferior survival (median OS 0.46 years), whereas chronic graft-versus-host disease (cGvHD) was associated with improved OS and RFS (above 50%). Conclusion: ClofCy is an effective bridging regimen enabling HSCT in patients with R/RR acute leukemia. Introducing ClofCy may improve the probability of reaching HSCT and long-term survival in this cohort of patients with poor prognosis.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria",
    "Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, 1090 Vienna, Austria",
    "Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria",
    "Center for Public Health, Department of Environmental Health, Medical University of Vienna, 1090 Vienna, Austria"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Irene Graf",
      "orcid": "0009-0007-0512-1580"
    },
    {
      "affs": [
        2
      ],
      "name": "Philipp Wohlfarth"
    },
    {
      "affs": [
        3
      ],
      "name": "Michael Kundi",
      "orcid": "0000-0002-2707-3213"
    },
    {
      "affs": [
        2
      ],
      "name": "Margit Mitterbauer"
    },
    {
      "affs": [
        2
      ],
      "name": "Axel Schulenburg"
    },
    {
      "affs": [
        0
      ],
      "name": "Alexander W. Hauswirth"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Karoline V. Gleixner"
    },
    {
      "affs": [
        2
      ],
      "name": "Hanna A. Knaus"
    },
    {
      "affs": [
        2
      ],
      "name": "Lina Z. Rüsing",
      "orcid": "0009-0004-6008-029X"
    },
    {
      "affs": [
        2
      ],
      "name": "Werner Rabitsch"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Peter Valent",
      "orcid": "0000-0003-0456-5095"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Wolfgang R. Sperr"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6jq16299xs2ac.bib",
  "cited_by": 0,
  "doi": "10.3390/cancers18213593",
  "fulltext_url": null,
  "id": "6jq16299xs2ac",
  "issns": [
    "2072-6694"
  ],
  "landing_url": "https://www.mdpi.com/2072-6694/18/21/3593",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-09",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/6jq16299xs2ac.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T00:21:40Z",
      "native_id": "10.3390/cancers18213593",
      "source": "crossref",
      "url": "https://www.mdpi.com/2072-6694/18/21/3593"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2072-6694",
      "subfield": "oncology"
    }
  ],
  "title": "Long-Term Survival of Patients with Relapsed/Refractory Acute Leukemia Receiving Clofarabine/Cyclophosphamide Prior to Hematopoietic Stem Cell Transplantation",
  "title_text": "Long-Term Survival of Patients with Relapsed/Refractory Acute Leukemia Receiving Clofarabine/Cyclophosphamide Prior to Hematopoietic Stem Cell Transplantation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-10T00:21:40Z",
  "url": "https://research.draconitic.com/paper/6jq16299xs2ac",
  "venue": "Cancers",
  "versions": []
}