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KMID : 0191120090240030498
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Journal of Korean Medical Science
2009 Volume.24 No. 3 p.498 ~ p.503
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The Clinical Outcome of FLAG Chemotherapy without Idarubicin in Patients with Relapsed or Refractory Acute Myeloid Leukemia
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Lee Se-Ryeon
Ahn Jae-Sook
Choi Young-Jin
Shin Ho-Jin
Chung Joo-Seop
Cho Yoon-Young
Chae Yee-Soo
Kim Jong-Gwang
Sohn Sang-Kyun
Kim Hyeoung-Joon
Yang Deok-Hwan
Kim Yeo-Kyeoung
Lee Je-Jung
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Abstract
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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 (≥500/μL) and platelets (≥20,000/μL) 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.
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KEYWORD
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Leukemia, Myeloid, Acute, FLAG Chemotherapy, Toxicity
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