171 Idarubicin, fludarabine, cytarabine and G-CSF (FLAG-IDA) for the treatment of high risk MDS or AML

Parker, Jane E.; Cullis, Jonathan O.; Mijović, Aleksandar; Pagliuca, Antonio; Rassam, S. M. B.; Samaratunga, I.R.; Grace, R.; Glover, Porter H.; Mufti, G J

doi:10.1016/s0145-2126(97)81399-9

Cited by 2 publications

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“…Poor results were also obtained in patients with karyotypic abnormalities at diagnosis, confirming the pivotal role of cytogenetics in predicting the clinical outcome in AML [19]. For patients with primary resistant AML as well as for those with adverse cytogenetic features at diagnosis, it may be reasonable to potentiate the FLAG with additional drugs such as idarubicin or mitoxantrone [20][21][22]. The toxicity of the regimen was mild considering that most patients had been heavily pretreated.…”

Section: Discussionmentioning

confidence: 97%

Fludarabine, cytarabine, and G-CSF (FLAG) for the treatment of poor risk acute myeloid leukemia

et al. 1998

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Thirty-eight patients with primary resistant or relapsing acute myeloid leukemia (AML) were treated with fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG). Median age was 41 (range 11-70). Sixteen patients had AML that was primary resistant to induction treatment, while 22 were relapsed, 11 after autologous bone marrow transplant (AuBMT), 8 less than 6 months from complete remission (CR) achievement, and 3 were second relapse from chemotherapy alone. Overall, 21 of 38 patients (55%) obtained CR. Age, sex, length of CR, and interval between autoBMT and FLAG administration did not significantly influence the CR rate. On the contrary, a normal karyotype at diagnosis was significantly related to a better outcome. There were 4 induction deaths (10%), due to fungal infection in 2 patients and hemorrhagic complications in the remaining two. All patients experienced profound cytopenia. Median time to neutrophil (>500/microl) recovery was 21 days, while a platelet count >20,000/microl was reached after 23 days. The median period of hospitalization was 31 days. The nonhematological toxicity was mild, mainly consisting of mucositis. There were 17 documented infections and 17 episodes of fever of unknown origin. Following CR achievement, 6 patients received autoBMT, 3 alloBMT, 2 high-dose arabinosil-cytosine, and 2 are on a waiting list for transplantation procedure. We conclude that FLAG is an effective and well-tolerated regimen for refractory or recurrent AML, mainly useful for patients to be admitted to bone marrow transplantation.

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Section: Discussionmentioning

confidence: 97%

Fludarabine, cytarabine, and G-CSF (FLAG) for the treatment of poor risk acute myeloid leukemia

et al. 1998

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Etiopathogeny, prognosis and therapy of myelodysplastic syndromes

Sanz

Vallespı́

1997

Hematol Cell Ther

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Myelodysplastic syndromes (MDS) are a heterogeneous and common group of clonal hematological disorders characterized by cytopenias, dysplastic changes of hematopoietic cells, and a high rate of transformation into acute myeloblastic leukemia (AML). MDS provide a clinical model for studying the emergency and progression of malignancy. The initiating events leading to MDS remain almost unknown. Imbalance of proliferative and differentiating capabilities of progenitor hematopoietic cells along with abnormalities in the normal process of apoptosis are involved in both the pathogenesis of MDS and transformation into AML. Multiple genomic lesions, comprising oncogene activation and tumor-suppressor gene inactivation, are probably required. Alkylating agents, cytotoxic drugs targeting topoisomerase II and benzene are the only clear etiological factors identified. Advanced age and great prognostic variability, not explained by the FAB subtype, complicates the design and analysis of clinical trials and therapy-planning. The use of recently developed prognostic scores for selecting the best treatment according to the expected risk is encouraged. In most patients therapy is unsatisfactory. At present, bone marrow transplantation is considered as the only curative approach. A better knowledge of the pathobiology of MDS should be valuable to develop new, more rationale and effective therapies.

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171 Idarubicin, fludarabine, cytarabine and G-CSF (FLAG-IDA) for the treatment of high risk MDS or AML

Cited by 2 publications

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Fludarabine, cytarabine, and G-CSF (FLAG) for the treatment of poor risk acute myeloid leukemia

Fludarabine, cytarabine, and G-CSF (FLAG) for the treatment of poor risk acute myeloid leukemia

Etiopathogeny, prognosis and therapy of myelodysplastic syndromes

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