J Korean Med Sci.  2009 Jun;24(3):498-503. 10.3346/jkms.2009.24.3.498.

The Clinical Outcome of FLAG Chemotherapy without Idarubicin in Patients with Relapsed or Refractory Acute Myeloid Leukemia

• Lee SR
• Yang DH
• Ahn JS
• Kim YK
• Lee JJ
• Choi YJ
• Shin HJ
• Chung JS
• Cho YY
• Chae YS
• Kim JG
• Sohn SK
• Kim HJ

• KMID: 1779170
• DOI: http://doi.org/10.3346/jkms.2009.24.3.498

Abstract

A refractory and resistant disease to conventional induction chemotherapy and relapsed disease are considered as the most important adverse prognostic factors for acute myeloid leukemia (AML). Sixty-one patients (median age, 33.6 yr) with relapsed or refractory AML were treated with the FLAG regimen that consisted of fludarabine (30 mg/m2, days 1-5), cytarabine (2.0 g/m2, days 1-5) and granulocyte colony-stimulating factor. Of the treated patients 29 patients (47.5%) achieved complete remission (CR). Higher CR rates were observed for patients with a first or second relapse as compared to patients with a primary refractory response or relapse after stem cell transplantation (HSCT). There was a significant difference in the response rates according to the duration of leukemia-free survival (pre-LFS) before chemotherapy (P=0.05). The recovery time of both neutrophils (> or =500/microL) and platelets (> or =20,000/microL) required a median of 21 and 18 days, respectively. Treatment-related mortality (TRM) occurred in seven patients (11.4%), of which 71.4% of TRM was caused by an invasive aspergillosis infection. After achieving CR, 18 patients underwent consolidation chemotherapy and six patients underwent allogeneic HSCT. In conclusion, FLAG chemotherapy without idarubicin is a relatively effective and well-tolerated regimen for relapsed or refractory AML and the use of FLAG chemotherapy has allowed intensive post-remission therapy including HSCT.

Keyword

Leukemia, Myeloid, Acute; FLAG Chemotherapy; Toxicity

MeSH Terms

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Cytarabine/*therapeutic use/toxicity
Disease-Free Survival
Female
Granulocyte Colony-Stimulating Factor/*therapeutic use/toxicity
Humans
Idarubicin/therapeutic use
Leukemia, Myeloid, Acute/*drug therapy/mortality
Male
Middle Aged
Recurrence
Treatment Outcome
Vidarabine/*analogs & derivatives/therapeutic use/toxicity

Figure

• 

  Fig. 1 The probability of leukemic free survival (LFS) and overall survival (OS) after FLAG chemotherapy in patients with relapsed or refractory AML (n=61).

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