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Published on: October 17, 2025
Clofarabine in leukemia.
Hady Ghanem1, Elias Jabbour, Stefan Faderl
1Department of Leukemia, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. hadyghanem@hotmail.com
Clofarabine, a purine nucleoside analogue, inhibits DNA replication and shows antitumor activity in acute leukemia. Its enhanced stability and phosphorylation affinity make it a promising agent for hematologic and solid tumors.
Area of Science:
- Pharmacology and Oncology
- Nucleoside Analogue Development
Background:
- Clofarabine is a second-generation purine nucleoside analogue designed to improve upon fludarabine and cladribine.
- It exhibits enhanced stability against deamination and phosphorolysis and higher affinity for deoxycytidine kinase (dCyd).
Purpose of the Study:
- To review the development, pharmacology, and clinical activity of clofarabine.
- To explore its emerging role in treating acute leukemia, myelodysplastic syndrome, and solid tumors.
Main Methods:
- A comprehensive literature review of original articles and related reviews.
- Searches were conducted using the MEDLINE (PubMed) database and meeting abstracts.
Main Results:
- Clofarabine inhibits ribonucleotide reductase and DNA polymerase, depleting deoxynucleoside triphosphates essential for DNA replication.
- Demonstrated single-agent antitumor activity in pediatric and adult acute leukemia since its first Phase I study in 1993.
- Combination regimens with clofarabine, particularly with cytarabine, are under evaluation due to its biochemical modulation properties.
Conclusions:
- Clofarabine possesses favorable pharmacological properties and has shown significant clinical activity in acute leukemia.
- Its potential application extends to myelodysplastic syndrome and solid tumors, warranting further investigation.
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