PETHEMA real-world study: FLAG-Ida salvage in R/R AML

Results from a multicenter, retrospective real-world analysis by the Programa Español de Tratamientos en Hematología (PETHEMA) group, evaluating fludarabine + cytarabine + granulocyte colony-stimulating factor + idarubicin (FLAG-Ida) as salvage therapy in adults with first relapsed/refractory (R/R) acute myeloid leukemia (AML; N = 1,079), were published in the American Journal of Hematology by Aspas Requena et al. The primary endpoint was overall survival (OS); secondary endpoints included complete remission composite (CRc), event-free survival (EFS), the proportion of patients proceeding to allogeneic hematopoietic stem cell transplantation (allo-HSCT), and validation of the SALFLAGE prognostic score. 

Key data: At a median follow-up of 50.9 months, the median OS was 10.2 months (95% confidence interval [CI], 9.0–11.7) and the median EFS was 4.5 months. Overall, 56.8% of patients achieved a CRc, 8.4% died during induction, and 35.2% proceeded to allo-HSCT. By SALFLAGE scoring, median OS was 22.2, 13.4, and 6.9 months and CRc rates were 76.0%, 63.3%, and 42.2% in the low-, intermediate-, and high-risk groups, respectively (p < 0.001). 

Key learning: FLAG-Ida is an effective salvage regimen for fit adults with R/R AML, enabling bridge-to-transplant in over one-third of patients, with the validated SALFLAGE score supporting risk-adapted salvage strategy selection.