FLAG-IDA in the treatment of refractory/relapsed acute myeloid leukemia: single-center experience

Pastore, Domenico; Specchia, Giorgina; Carluccio, Paola; Liso, Arcangelo; Mestice, Anna; Rizzi, Rita; Greco, Gianpiero; Buquicchio, Caterina; Liso, Vincenzo

doi:10.1007/s00277-003-0624-2

Cited by 88 publications

(43 citation statements)

References 22 publications

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“…A number of studies of FLAG along with idarubicin (IDA-FLAG regimen) for treating patients of refractory or relapsed AML have been reported. The CR rates were 42 and 52%, respectively, which were similar to FLAG (20,21). Mitoxantrone is one of the most common drugs in AML therapy, particularly in refractory or relapsed AML.…”

Section: Discussionmentioning

confidence: 54%

Clinical study of Mito-FLAG regimen in treatment of relapsed acute myeloid leukemia

Luo

Cai

Jiang

et al. 2013

Experimental and Therapeutic Medicine

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Patients with relapsed acute myeloid leukemia (AML) have unfavorable prognosis and require innovative therapeutic approaches. In this study we used fludarabine combined with a middle dose of cytosine arabinoside (Ara-C), mitoxantrone and granulocyte-colony stimulating factor (G-CSF) as a salvage therapy for patients with relapsed AML in China. Forty-five patients with relapsed AML were treated with the Mito-FLAG regimen consisting of mitoxantrone (7 mg/m2, day 1, 3 and 5), fludarabine (30 mg/m2, days 1–5), Ara-C (1 g/m2, over 3 h every 12 h, days 1–5) and G-CSF [5 μg/kg/day subcutaneously from day 0 until the white blood count (WBC) was >20×109/l]. Patients with a partial response (PR) received another course of the same regimen. Patients with a suitable donor and aged <50 years received allogeneic stem cell transplantation (allo-SCT). Twenty-three patients (51%) and 3 patients (7%) achieved complete remission (CR) and PR, respectively, following one or two courses of Mito-FLAG, and the overall response (OR) rate was 58%. Nine patients (20%) received allo-SCT and 4 patients (9%) succumbed early. Hematological toxicity and infections were the most prominent toxicities of this regimen. Other toxicities included nausea, vomiting, bleeding, hyperbilirubinemia, renal toxicity and arrhythmia. The probability of overall survival (OS) at 4 years was 19% (95% CI, 11–26%) and the probability of 4-year disease-free survival (DFS) was 29% for all 23 patients in CR (95% CI, 18–41%). Our data suggest that Mito-FLAG is a highly effective and well-tolerated salvage regimen for relapsed AML.

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Section: Discussionmentioning

confidence: 54%

Clinical study of Mito-FLAG regimen in treatment of relapsed acute myeloid leukemia

Luo

Cai

Jiang

et al. 2013

Experimental and Therapeutic Medicine

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“…Various studies have determined the clinical response of the FLAG regimen or with idarubicin (9, 10, 12-14, 20) to be between 50 and 81%. Yavuz et al (21) and Pastore et al (22) suggested that the CR rate of FLAG-ida was 53.6 and 52.1% in the treatment of the patients with relapsed and refractory AML, respectively. In our study, the complete remission rate of FLAG without idarubicin was 47.5%, similar to that of FLAG with idarubicin.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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 (≥500/µL) and platelets (≥20,000/µL) 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.

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“…The patient achieved complete remission, but then relapsed after 5 months. Reinduction chemotherapy using a FLAG-IDA regimen6 - fludarabine (30 mg/m 2 , days 1-5), cytosine-arabinoside (2 g/m 2 , days 1-7), and idarubicin (10 mg/m 2 , day 1-3) failed to induce remission. The patient was then treated with two more cycles of reinduction chemotherapy, but did not achieve complete remission.…”

Section: Case Reportmentioning

confidence: 99%

A Case of Pathologic Splenic Rupture as the Initial Manifestation of Acute Myeloid Leukemia M2

Han

Kim

et al. 2010

Yonsei Med J

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A pathologic splenic rupture refers to a rupture without trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare. In this study, we described a rare case of acute myeloid leukemia presenting principally as an acute abdomen due to a pathologic splenic rupture in a 35-year old male patient. We can assert that a pathologic splenic rupture in hematologic diseases is a potentially life-threatening complication, which necessitates immediate operative intervention. Any such patient complaining about left upper abdominal tenderness should be closely observed, and further diagnostic investigations (ultrasonograph of the abdomen, abdominal CT scan) should be initiated in order to rule out a splenic rupture. The oncologist should be aware of this rare initial presentation of acute myeloid leukemia (AML) M2, as the condition generally necessitates a prompt splenectomy.

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FLAG-IDA in the treatment of refractory/relapsed acute myeloid leukemia: single-center experience

Cited by 88 publications

References 22 publications

Clinical study of Mito-FLAG regimen in treatment of relapsed acute myeloid leukemia

Clinical study of Mito-FLAG regimen in treatment of relapsed acute myeloid leukemia

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

A Case of Pathologic Splenic Rupture as the Initial Manifestation of Acute Myeloid Leukemia M2

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