What is the role of cladribine in the treatment of acute myeloid leukemia (AML)?

Updated: May 26, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Purine analogs increase intracellular uptake of cytarabine by accumulation of cytarabine triphosphate (ara-CTP) in leukemia blasts. A preliminary trial by the Polish Adult Leukemia Group demonstrated a significantly increased complete remission rate when cladribine was added to cytarabine and daunorubicin. [48]

In a larger trial, 652 patients with AML, aged 17 to 60 years, were randomized to receive daunorubicin and cytarabine (DA), DA plus cladribine, or DA plus fludarabine. Complete remission was higher with DA plus cladribine compared with DA (67.5% versus 56%, respectively, P=0.01). The improvement was due to a reduction in resistant disease. Overall survival was also improved with DA plus cladribine versus DA (45% versus 33% at 3 years, respectively, P=0.02). There was no benefit to the addition of fludarabine to DA except in the subset of patients with adverse karyotype. [49]


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