Flag-IDA regimen as salvage chemotherapy before haematopoetic stem cell transplantation in the treatment of refractory/relapsed acute myeloblastic leukaemia: single-centre experience
Journal
Bone Marrow Transplatation Journal
Date Issued
2011
Author(s)
Dukovski, Dushko
DOI
10.1038/bmt.2011.48
Abstract
During the past several decades, improvements in chemotherapeutic
regimens and supportive care have resulted in signifi cant
but modest progress in treating AML.Conventional chemotherapy
is highly effective in the treatment of acute myeloblastic
leukemia (AML). About 50-80% of adult patients with de novo
acute myeloblastic leukemia achieve complete remission (CR)
with currently available chemotherapy regimens consisting of
antracyclines and cytarabine. However, relapse develops in
more that 40% of the cases within two years, and 15-25% of
patients fail to achieve complete remission because resistant
to treatment or death. The management of cases with primary
refractory and /or relapse disease is very diffi cult and prognosis
in this subset of patients after several different chemotherapy
combinations is still very poor with a CR rate 33-41%.
We evaluated effi cacy and toxicity profi les of FLAG-Ida combination
chemotherapy as salvage chemotherapy before
hematopoietic stem cell transplantation in patients with refractory/
relapsed AML.
At the University Hematology Clinic in Skopje, Macedonia, in
the period 2006-2009, twenty patients with refractory/relapsed
acute myeloblastic leukemia were treated with FLAG-Ida regiment.
Patients were between 16-52 years old, 6 female and
14 male. They were treated with fl udarabine 30 mg/m2, cytosine
arabinoside (AraC) 2 g/m2 for 5 days, Idarubicin 10 mg/m2
for 3 days, and granulocyte colony stimulating factor G-CSF 5 mikrog/kg from day 0 till neutrofi l recovery (ANC >1.0 x109/l).
Complete remission were achieved in 9 patients (45%), four
patients (25%) died of post chemotherapy complications, and
7 failed to achieve complete remission. Out of 9 patients who
achieved complete remission, 4 went autologous bone marrow
transplantation, 4 went allogeneic bone marrow transplantation,
and 1 is being evaluated for the same. Major complication
encountered were mucosistis, transient hepatic toxicity, fungal
and bacterial infections.
Our experience confi rmed that FLAG-IDA regimen is well tolerated
and effective therapy in relapsed/refractory acute myeloid leukemia.
FLAG-Ida is a good choice in cases with refractory/relapsed
acute myeloblastic leukemia for salvage chemotherapy and it is
wise to consolidate it with hematopoietic stem cell transplantation.
Those patients included in the hematopoietic progenitor transplant
program, clearly benefi t from allogeneic or autologous BMT,
obtaining a longer disease free survival and overall survival.
regimens and supportive care have resulted in signifi cant
but modest progress in treating AML.Conventional chemotherapy
is highly effective in the treatment of acute myeloblastic
leukemia (AML). About 50-80% of adult patients with de novo
acute myeloblastic leukemia achieve complete remission (CR)
with currently available chemotherapy regimens consisting of
antracyclines and cytarabine. However, relapse develops in
more that 40% of the cases within two years, and 15-25% of
patients fail to achieve complete remission because resistant
to treatment or death. The management of cases with primary
refractory and /or relapse disease is very diffi cult and prognosis
in this subset of patients after several different chemotherapy
combinations is still very poor with a CR rate 33-41%.
We evaluated effi cacy and toxicity profi les of FLAG-Ida combination
chemotherapy as salvage chemotherapy before
hematopoietic stem cell transplantation in patients with refractory/
relapsed AML.
At the University Hematology Clinic in Skopje, Macedonia, in
the period 2006-2009, twenty patients with refractory/relapsed
acute myeloblastic leukemia were treated with FLAG-Ida regiment.
Patients were between 16-52 years old, 6 female and
14 male. They were treated with fl udarabine 30 mg/m2, cytosine
arabinoside (AraC) 2 g/m2 for 5 days, Idarubicin 10 mg/m2
for 3 days, and granulocyte colony stimulating factor G-CSF 5 mikrog/kg from day 0 till neutrofi l recovery (ANC >1.0 x109/l).
Complete remission were achieved in 9 patients (45%), four
patients (25%) died of post chemotherapy complications, and
7 failed to achieve complete remission. Out of 9 patients who
achieved complete remission, 4 went autologous bone marrow
transplantation, 4 went allogeneic bone marrow transplantation,
and 1 is being evaluated for the same. Major complication
encountered were mucosistis, transient hepatic toxicity, fungal
and bacterial infections.
Our experience confi rmed that FLAG-IDA regimen is well tolerated
and effective therapy in relapsed/refractory acute myeloid leukemia.
FLAG-Ida is a good choice in cases with refractory/relapsed
acute myeloblastic leukemia for salvage chemotherapy and it is
wise to consolidate it with hematopoietic stem cell transplantation.
Those patients included in the hematopoietic progenitor transplant
program, clearly benefi t from allogeneic or autologous BMT,
obtaining a longer disease free survival and overall survival.
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