Flag-IDA regimen as salvage chemotherapy before haematopoetic stem cell transplantation in the treatment of refractory/relapsed acute myeloblastic leukaemia: single-centre experience

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.