FLAG (fludarabine + high-dose cytarabine + G-CSF): an effective and tolerable protocol for the treatment of 'poor risk' acute myeloid leukemias.

摘要: Twenty-eight patients with poor prognosis acute myeloid leukemia (AML) received therapy two courses of fludarabine 30 mg/m2/day + ara-C 2 g/m2/day (days 1-5) and G-CSF 5 mg/kg/day (FLAG) (from day 0 to polymorphonuclear recovery). Eighteen were considered 'refractory' (eight primarily resistant, five relapsing within 6 months initial remission, or at a second relapse; after an autologous bone marrow transplantation procedure. Ten cases defined 'secondary' AML (diagnosis made preexisting diagnosis of: myelodysplastic syndrome: cases; syndrome for breast cancer: one case; previously untreated, concomitant, non-Hodgkin's lymphoma: Hodgkin's disease treated chemoradiotherapy: case). Overall, 15 (58%) achieved complete remission (CR). Two died infection during induction, 11 had resistant disease. Analyzing the data in relation selected host characteristics, response varied widely. The highest CR rates (89%) obtained secondary AML; particular, 'second-primary' (concomitant low-grade lymphoma) both diseases. Refractory differed widely response: high rate (75%), although short mean duration primary resistance AML, very (11% CR) relapsed (early, second, ABMT) cases. Interestingly, slow kinetic leukemic growth vivo before FLAG administration was significantly related outcome (p = 0.0002). Hematological nonhematological toxicities acceptable. In conclusion, regimen has significant antileukemic activity acceptable toxicity especially without coexisting lymphoid malignancy.