Intensive treatment regimens for relapsed/refractory (R/R) acute myeloid leukemia (AML) generally include an anthracycline, cytarabine, with or without a purine analogue. In patients who cannot tolerate an anthracycline due to comorbidities may consider using etoposide. Given the ongoing fludarabine shortage, it has prompted the switch to other purine analogues, such as cladribine, in combination with cytarabine and etoposide in patients who may be eligible for intensive chemotherapy but not able to tolerate an anthracycline due to comorbidities or cardiotoxicity risks. Here we present four patients who received a CCE (cladribine, cytarabine, and etoposide) based regimen for R/R AML. There were no significant therapy-related adverse events, dose holds or delays. Two out of three evaluable patients were successfully bridged to allogeneic transplant, and one is pending another cycle of chemotherapy as a bridge to transplant. The CCE regimen offers a potential option for patients with R/R AML in need of an anthracycline free salvage regimen during a fludarabine shortage.

中文翻译：

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基于克拉屈滨、阿糖胞苷和依托泊苷 (CCE) 的治疗方案对于复发性和难治性 AML 患者是安全且可耐受的。

复发/难治性 (R/R) 急性髓系白血病 (AML) 的强化治疗方案通常包括蒽环类药物、阿糖胞苷，含或不含嘌呤类似物。对于因合并症而不能耐受蒽环类药物的患者，可以考虑使用依托泊苷。鉴于氟达拉滨持续短缺，对于可能适合接受强化化疗但由于合并症或心脏毒性风险而无法耐受蒽环类药物的患者，促使其改用其他嘌呤类似物，例如克拉屈滨，与阿糖胞苷和依托泊苷联合使用。在此，我们介绍了四位接受基于 CCE（克拉屈滨、阿糖胞苷和依托泊苷）治疗方案的 R/R AML 患者。没有明显的治疗相关不良事件、剂量保留或延迟。三分之二的可评估患者成功过渡到同种异体移植，其中一名患者正在等待另一周期的化疗作为移植的过渡。CCE 方案为在氟达拉滨短缺期间需要无蒽环类药物抢救方案的 R/R AML 患者提供了一个潜在的选择。