{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:35:50Z","timestamp":1760142950612,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T00:00:00Z","timestamp":1705017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Arlene Witmer Memorial Fund for Bone Marrow Cancer Research"},{"name":"The John and Denise Gilliland Fund for the Cancer Genetics Program"},{"name":"G. R. Sponaugle Employee Cancer Research Fund"},{"name":"Richard E. and Stephanie A. Ziegler Charitable Foundation Endowment in Hematology"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Acute myeloid leukemia patients with induction failure or relapsed refractory disease have minimal chance of achieving remission with subsequent treatments. Several trials have shown the feasibility of clofarabine-based conditioning in allogeneic stem cell transplants (allo-HSCT) for non-remission AML patients. Pre-transplant conditioning with clofarabine followed by reduced-intensity allo-HSCT has also demonstrated a potential benefit in those patients with human leukocyte antigen (HLA)-identical donors, but it is not commonly used in haploidentical and mismatched transplants. In this case report, we describe our experience of seven cases of non-remission AML who received clofarabine preconditioning followed by an allo-HSCT with PTCy. The 2-year overall survival and disease-free survival was 83.3% (95% confidence interval (CI): 27.3\u201397.9%) and 85.7% (95% CI: 33.4\u201397.9%). Median days of neutrophil and platelet recovery were 16 (range of 13\u201323) and 28 (range of 17\u201375), respectively. The cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) at day 100 and chronic GVHD at 1-year showed 28.6% (95% CI: 8\u201374.2%) and 28.6% (95% CI: 3\u201363.9%), respectively. The two-year relapse rate was 14.3% (95% CI: 2.14\u201366.6%). One-year GVHD-free relapse-free survival (GFRS) at 1-year was 71.4% (95% CI: 25.8\u201392%). Our patients showed successful outcomes with clofarabine preconditioning to reduce the leukemic burden at the pre-transplant period followed by PTCy to reduce GVHD resulting in lower relapsed rate and better GFRS in these patients.<\/jats:p>","DOI":"10.3390\/ijms25020957","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T07:47:16Z","timestamp":1705045636000},"page":"957","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clofarabine Preconditioning followed by Allogeneic Transplant Using TBI and Post-Transplant Cyclophosphamide for Relapsed Refractory Leukemia"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9859-151X","authenticated-orcid":false,"given":"Seema","family":"Naik","sequence":"first","affiliation":[{"name":"Department of Medicine, Penn State Cancer Institute, 500 University Dr. Hershey, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7441-9531","authenticated-orcid":false,"given":"Kevin","family":"Rakszawski","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Cancer Institute, 500 University Dr. Hershey, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Cancer Institute, 500 University Dr. Hershey, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9209-2405","authenticated-orcid":false,"given":"David","family":"Claxton","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Cancer Institute, 500 University Dr. Hershey, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Minagawa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Cancer Institute, 500 University Dr. Hershey, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin","family":"Mineishi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Penn State Cancer Institute, 500 University Dr. Hershey, Hershey, PA 17033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1182\/blood-2003-03-0925","article-title":"Phase 2 clinical and pharmacologic study of clofarabine in patients with refractory or relapsed acute leukemia","volume":"102","author":"Kantarjian","year":"2003","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1002\/cncr.30536","article-title":"Allogeneic transplantation for advanced acute myeloid leukemia: The value of complete remission","volume":"123","author":"Weisdorf","year":"2017","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1016\/j.bbmt.2016.06.023","article-title":"Long-Term Outcomes after Treatment with Clofarabine\u2009\u00b1\u2009Fludarabine with Once-Daily Intravenous Busulfan as Pretransplant Conditioning Therapy for Advanced Myeloid Leukemia and Myelodysplastic Syndrome","volume":"22","author":"Alatrash","year":"2016","journal-title":"Biol. 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