Outcomes of fludarabine, high dose cytarabine and granulocyte-colony stimulating factor (FLAG) as re-induction for residual acute myeloid leukemia on day 14 bone marrow

Omer Jamy; Sejong Bae; Luciano J Costa; Harry P Erba; Nikolaos Papadantonakis

doi:10.1016/j.leukres.2018.09.014

Outcomes of fludarabine, high dose cytarabine and granulocyte-colony stimulating factor (FLAG) as re-induction for residual acute myeloid leukemia on day 14 bone marrow

Leuk Res. 2018 Nov:74:64-67. doi: 10.1016/j.leukres.2018.09.014. Epub 2018 Sep 27.

Authors

Omer Jamy¹, Sejong Bae², Luciano J Costa³, Harry P Erba³, Nikolaos Papadantonakis⁴

Affiliations

¹ Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
² Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: npapadantonakis@uabmc.edu.

PMID: 30300822
DOI: 10.1016/j.leukres.2018.09.014

Abstract

Background: Patients with acute myeloid leukemia (AML) treated with intensive chemotherapy may require re-induction based on the evaluation of day 14 bone marrow biopsy.

Methods: A retrospective chart review was performed to evaluate adult patients with AML who received re-induction with fludarabine, high dose cytarabine and granulocyte colony stimulating factor (FLAG) regimen for residual disease (≥ 5% blasts by morphology) on day 14 bone marrow examination between September 2012 and July 2017 at our institution.

Results: We identified 27 patients who received FLAG therapy for treatment of residual disease on day 14 marrow examination following initial induction. The median age at diagnosis was 61 years and the majority of patients had poor risk AML. The overall response rate was 78% and 15 patients proceeded to allogeneic hematopoietic stem cell transplantation.

Conclusion: The regimen was well tolerated and is a viable re-induction option for patients with residual disease on a day 14 bone marrow.

Keywords: Acute myeloid leukemia; Day 14 bone marrow; FLAG; Re-induction; Residual disease.

Publication types

Clinical Trial

MeSH terms

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
Bone Marrow* / metabolism
Bone Marrow* / pathology
Cytarabine / administration & dosage
Female
Granulocyte Colony-Stimulating Factor / administration & dosage
Humans
Leukemia, Myeloid, Acute* / drug therapy
Leukemia, Myeloid, Acute* / metabolism
Leukemia, Myeloid, Acute* / pathology
Male
Middle Aged
Neoplasm, Residual
Retrospective Studies
Risk Factors
Time Factors
Vidarabine / administration & dosage
Vidarabine / analogs & derivatives*

Substances

Cytarabine
Granulocyte Colony-Stimulating Factor
Vidarabine

Supplementary concepts

FLAG protocol