Clofarabine as a potential stimulant of alloreactivity

Abstract

DLI is a treatment option for malignancy relapses occurring after allogeneic hematopoietic SCT (HSCT).1, 2 The graft-versus-tumor effect of DLI results from donor T-cell alloreactivity directed against recipient antigens, and correlates with GVHD development. Most patients with relapse after HSCT primarily need to receive conventional chemotherapy to reduce tumor burden before DLI. In HSCT patients exhibiting GVHD clinical manifestations at the time of relapse, the primary use of chemotherapy is quasi-constantly associated with donor T-cell alloreactivity reduction, as assessed by GVHD improvement or even disappearance. In contrast, GVHD elicitation by chemotherapy administration represents an unexpected event. We report such an unusual episode of acute GVHD occurring in an allo-transplanted patient after salvage chemotherapy of leukemia relapse using clofarabine, a second-generation purine analog that has proven efficacy in patients with relapsed leukemia.3, 4