The Clinical Outcome of FLAG Chemotherapy without Idarubicin in Patients with Relapsed or Refractory Acute Myeloid Leukemia.
10.3346/jkms.2009.24.3.498
- Author:
Se Ryeon LEE
1
;
Deok Hwan YANG
;
Jae Sook AHN
;
Yeo Kyeoung KIM
;
Je Jung LEE
;
Young Jin CHOI
;
Ho Jin SHIN
;
Joo Seop CHUNG
;
Yoon Young CHO
;
Yee Soo CHAE
;
Jong Gwang KIM
;
Sang Kyun SOHN
;
Hyeoung Joon KIM
Author Information
1. Blood and Marrow Transplant Center, Hwasun, Korea. hjoonk@chonnam.ac.kr
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Leukemia, Myeloid, Acute;
FLAG Chemotherapy;
Toxicity
- MeSH:
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
- From:Journal of Korean Medical Science
2009;24(3):498-503
- CountryRepublic of Korea
- Language:English
-
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.
