Treatment with IDA-FLAG (idarubicin, fludarabine, cytarabine, G-CSF) Regimen in Children with Myelodysplastic Syndrome and Relapsed/Refractory Acute Myelogenous Leukemia

Lee, Sang Hee; Kim, Sun Young; Jang, Pil Sang; Chung, Nak Gyun; Cho, Bin; Jeong, Dae Chul; Kim, Hack Ki

Abstract

PURPOSE: The prognosis of refractory or relapsed acute myelogenous leukemia (AML) is poor and effective reinduction regimens are rare. Myelodysplastic syndrome (MDS) is a heterogenous group of clonal disorders of hematopoiesis and the outcome for children with MDS is poor, and the optimal treatment of MDS has not been defined. This study was undertaken to investigate the therapeutic results of IDA-FLAG (idarubicin, fludarabine, cytarabine, G-CSF) in children with MDS and relapsed or refractory AML.
METHODS
Eleven children with refractory or relapsed AML and ten with MDS were treated with the IDA-FLAG regimen, a combination therapy of idaraubicin (day 1~3, 12 mg/m2/day), fludarabine (day 1~5, 30 mg/m2/day), cytarabine (day 1~5, 2 g/m2/day) and G-CSF (day 0~5, 400 g/m2/day & day 12 up to ANC > 1,000/L, 5 g/kg/day).
RESULTS
In AML group, they received a total 15 courses of IDA-FLAG. Complete remission (CR) was achieved in 4/11 (36.4%) with median remission duration of 3 (2~6) months. In MDS group, they received 13 courses of IDA-FLAG and 8 courses of FLAG (IDA-FLAG without idarubicin). CR was achieved in 6/8 (75.0%) with median remission duration of 4 (2~13) months. All the patients experienced grade 4 hematologic toxicities. The median duration of neutropenia (<500/ mm3) and thrombocytopenia (<30,000/mm3) was 23 days (20~46 days) and 23.5 days (16~44 days) in AML, meanwhile those were 18 days (14~30 days) and 16 days (13~32 days) in MDS, respectively. Infectious complications were the main non-hematological toxicity. Two patients died of sepsis and intracerebral hemorrhage on day 7 and 27, respectively.
CONCLUSION
IDA-FLAG may be an efficient reinduction therapy for resistant and intensively pretreated AML and an effective regimen for poor prognostic MDS with acceptable toxicity, even though remission duration seems to be relatively short. Therefore, an intensified post-remission therapy seems necessary.