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Outcomes of patients with acute myeloid leukemia receiving FLAG re-induction
In some cases, patients with acute myeloid leukemia (AML) require re-induction, based on results of the day 14 bone marrow (BM) biopsy. Omer Jamy from the Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, and colleagues retrospectively analyzed adult patients with AML to evaluate 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. The results of the study were published ahead of print in Leukemia Research.
Twenty-seven patients (median age at diagnosis = 61 years, range 19–77) who received re-induction with FLAG from September 2012 to July 2017 at their institution were included in this analysis. As standard induction chemotherapy, cytarabine and an anthracycline (daunorubicin = 14, idarubicin = 13) without any small molecule inhibitors were administered.
Key findings:
- The majority of patients had poor risk AML
- Overall response rate (ORR): 78% (95% CI, 57.7%–4%)
- Complete remission (CR) rate: 63% (95% CI, 42.4%–6%)
- Fifteen patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT)
- Three patients (11%) died during hospitalization due to infections
The authors concluded that despite the retrospective nature of their study, FLAG re-induction regimen was well tolerated and efficient with a low mortality rate in patients with AML. FLAG may be a reasonable salvage option for fit patients with AML with residual disease on day 14 after standard induction therapy.
References
Jamy O. et al. 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 September 27. DOI: 10.1016/j.leukres.2018.09.014. [Epub ahead of print].