FLAG salvage therapy combined with idarubicin in relapsed/refractory acute myeloid leukemia

Leuk Lymphoma. 2019 Apr;60(4):1014-1022. doi: 10.1080/10428194.2018.1508670. Epub 2018 Oct 2.

Abstract

Acute myeloid leukemia (AML) is characterized by a high failure rate to achieve complete remission as well as high relapse rates that cause an emergent need for efficient and tolerable salvage therapies. The combination of FLAG with idarubicin (FLAG-Ida) is a widely used protocol. However, its efficacy has been analyzed in only a limited number of studies with majorly small patient cohorts. Here, we analyzed 132 patients with largely primary refractory or first-time relapsed AML treated according to the FLAG-Ida protocol. The overall complete remission rate (CR + CRi) was 56% with a median overall survival of 15 months (95% CI, 5.7-25.1). The median disease-free survival for CR/CRi-patients was not reached. The mortality rate on day 30 was 9% and increased on day 60 to 16%. Our results show in relapsed/refractory AML patients a high efficacy and compatibility for the FLAG-Ida regimen.

Keywords: Acute myeloid leukemia; FLAG-Ida; anthracycline; salvage therapy.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cytarabine / adverse effects
  • Cytarabine / therapeutic use
  • Drug Resistance, Neoplasm
  • Female
  • Granulocyte Colony-Stimulating Factor / adverse effects
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Humans
  • Idarubicin / administration & dosage*
  • Kaplan-Meier Estimate
  • Leukemia, Myeloid, Acute / drug therapy*
  • Leukemia, Myeloid, Acute / mortality
  • Leukemia, Myeloid, Acute / pathology*
  • Male
  • Middle Aged
  • Recurrence
  • Remission Induction
  • Salvage Therapy
  • Treatment Outcome
  • Vidarabine / adverse effects
  • Vidarabine / analogs & derivatives*
  • Vidarabine / therapeutic use
  • Young Adult

Substances

  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Vidarabine
  • Idarubicin

Supplementary concepts

  • FLAG protocol