The fludarabine, cytarabine, and granulocyte colony‐stimulating factor (FLAG) chemotherapy regimen is an alternative to anthracycline‐based therapy for the treatment of acute myeloid leukemia for patients with pre‐existing cardiac disease

Abstract

We conducted a retrospective study assessing FLAG (fludarabine, cytarabine, and granulocyte colony-stimulating factor) as first-line treatment in 56 newly diagnosed acute myeloid leukemia patients considered ineligible for anthracycline-based treatment due to advanced age, significant comorbidities, or pre-existing cardiac disease. The median age was 69 (21-80); 46% received FLAG for pre-existing cardiac disease and others due to age (32%), non-cardiac comorbidities (20%), or previous anthracycline exposure (2%). The induction mortality was 16% and, among evaluable patients, 48% achieved a complete remission after the first induction course with an additional patient achieving a remission after a second course for a total complete remission rate of 50%. Four patients proceeded to an allogeneic stem cell transplant including two with pre-existing cardiac disease. Among non-transplanted patients, the relapse rate (RR) was 47%. When censored at time of stem cell transplant, the median relapse-free survival was 14.7 months. The median overall survival was 9.3 months with 1- and 2-yr survivals of 44% and 22%, respectively. There was no difference in clinical outcomes between patients treated with FLAG for cardiac reasons vs. other reasons. In conclusion, FLAG is a useful alternative to anthracycline-based induction for Acute myeloid leukemia in those with significant comorbidities including pre-existing cardiac disease.

RNA Targeting in Acute Myeloid Leukemia

“…In addition to gaining new mechanistic insights, our results may provide a future means for predicting AML clinical responses to ara-C and thereby inform personalized chemo- therapy decisions. In cases where unfavorable anabolic profiles are predicted, potential alternatives to cytarabine include cladribine, 48 fludarabine, 49 and clofarabine 50 that are known to be effective against AML as single agents and when combined with cytarabine. In addition to AML, this same type of anabolic profiling approach should be applicable to other 2′(S)modified arabinoside derivatives that are used in front-line chemotherapeutic regimens, such as gemcitabine, fludarabine, and clofarabine for non-Hodgkin's lymphoma, chronic lymphocytic leukemia, acute lymphoblastic leukemia, pancreatic cancer, metastatic bladder cancer, and nonsmall cell lung cancer.…”