Clofarabine in High Risk Myelodysplastic Syndrome (MDS)

Inclusion Criteria:

• Patients aged 18 years or more with MDS according to FAB classification and intermediate-2 or high IPSS risk scores, or CMML (with WBC < 13 x 109/L and bone marrow blasts > 10 %) according to WHO classification, or AML according to WHO classification if less than 30 % bone marrow blasts (RAEB-T according to FAB MDS classification or AML according to WHO classification with more than 30 % with bone marrow blasts only if preceded by a proven MDS phase.
• Patients previously treated by azacitidine (Vidaza®) in proven progression, or stable after 6 courses with ongoing transfusion dependent anemia (> 4 RBC units in the 8 weeks preceding inclusion (as erythroid response in IWG 2006 criteria is reduction of at least 4 RBC units in 8 weeks).
• Previous biological and or targeted therapies of MDS or AML are allowed if stopped more than 1 month before inclusion.
• ECOG PS ≤ 2.

• Adequate renal and liver function :

  i.e. Serum creatinine < 110 microM in men or 90 microM in women. If plasma creatinine level < 90 - 110 microM, then the estimated glomerular filtration rate (GFR) must be < 50 mL/min/1.73 m2 as calculated by the Modification of Diet in Renal Disease (MDRD) equation where Predicted GFR (mL/min/1.73 m2) = 32788 x (plasma creatinine level (microM)-1.154 x (age in years)-0.023 x (0.742 if patient is female) x (1.212 if patient is African American)

• Bilirubin < 1.5 x ULN, (except increased unconjugated bilirubin due to dyserythropoiesis).
• Aspartate transaminase (AST)/alanine transaminase (ALT) < 2.5 × ULN and Alkaline phosphatase < 2.5 × ULN.
• Absence of pregnancy or lactation in female patients (Female patients of childbearing potential must have a negative serum pregnancy test within 2 weeks prior to enrollment).
• Male and female patients must use an effective contraceptive method during the study and for a minimum of 6 months after study treatment.
• Provided signed written informed consent.
• Capable of understanding the investigational nature, potential risks and benefits of the study, and able to provide valid informed consent.

Exclusion Criteria:

• Patients with AML and bone marrow blasts count of 20-30%, if candidates to intensive AML type chemotherapy.
• Known hypersensitivity to clofarabine or excipients.
• Concomitant malignant disease.
• Active uncontrolled infection (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment).
• Concomitant severe cardiovascular disease, i.e. congestive heart failure (NYHA grade > 3).
• Any significant concurrent disease, illness, or psychiatric disorder that would compromise patient safety or compliance, interfere with consent, study participation, follow up, or interpretation of study results.
• No affiliation to a national insurance scheme directly or to an equivalent system.
• Chemotherapy, radiation therapy, or immunotherapy other than as specified in the protocol.
• Use of investigational agents within 30 days or any anticancer therapy within 2 weeks before study entry with the exception of hydroxyurea. The patient must have recovered from all acute toxicities from any previous therapy.