Enhanced skin toxicity associated with the combination of clofarabine plus cytarabine for the treatment of acute leukemia

Purpose: Skin toxicity is associated with a number of different chemotherapeutic agents used to treat acute leukemias. The term "toxic erythema of chemotherapy" (TEC) has been coined to describe a spectrum of skin findings, ranging from palmar-plantar erythrodysesthesia to erythema of major body folds, with erythroderma representing its most severe form. To clarify the types and frequencies of cutaneous reactions associated with clofarabine plus cytarabine chemotherapy and to compare these to those observed with clofarabine alone, we reviewed our institutional experience over a 5-year period. Methods: We reviewed the medical records of 49 patients who were treated with either regimen for acute leukemia. To facilitate comparison of the cutaneous toxicities, only patients treated with clofarabine 40 mg/m² daily for 5 days (days 1-5) with or without cytarabine 1 g/m² daily for 5 days (days 2-6) were included. Results: Ten patients were treated with clofarabine alone, and 40 patients received clofarabine plus cytarabine; one patient received both regimens. Treatment-associated skin toxicity developed 3-9 days following the initiation of chemotherapy and was more common in the group receiving the two-drug combination as compared to those receiving clofarabine alone [22/40 (55 %) vs. 1/10 (10 %) respectively, p = 0.014]. The majority of chemotherapy-related cutaneous side effects represented TEC. Conclusions: Cutaneous toxicity was common and more frequent in the clofarabine plus cytarabine group when compared to patients treated with clofarabine alone. This finding is relevant for both clinicians and patients.