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Published pharmacokinetic analysis revealed no difference in peak plasma or intracellular concentrations at clofarabine dosed above 40 mg\/m<jats:sup>2<\/jats:sup>, yet inhibition of replication in leukemia cells was only sustained over 24 hr at 55 mg\/m<jats:sup>2<\/jats:sup>. Despite this, there have been no reports of high dose clofarabine used in this setting. Our experience implies that there may be a niche role for clofarabine in reducing disease burden before allo\u2010HSCT for adults with relapsed ALL. Am. J. Hematol., 2009. 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