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FLAG-IDA in the treatment of refractory/relapsed adult acute lymphoblastic leukemia.
Ann Hematol. 2005 Nov; 84(12):792-5.AH

Abstract

Relapsed or refractory adult acute lymphoblastic leukemias (ALL) have poor prognosis. The strategy for treating these patients is through reinduction chemotherapy followed by allogeneic stem cell transplantation, provided that the toxicity of the salvage regimen is acceptable. Twenty three patients with relapsed/refractory adult ALL were treated with fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin (FLAG-IDA). Five patients had primary refractory disease, and 18 were in first relapse. Nine (39.1%) patients achieved complete remission (CR) following salvage therapy, whereas 13 (56.5%) patients were refractory, and one patient died in aplasia due to infection. In patients achieving remission, the median time to reach absolute neutrophil count (ANC) more than 0.5x10(9)/l and 1x10(9)/l was 20 (range 16-25) and 24 (range 20-28) days from the start of chemotherapy, respectively. Platelet levels of more than 20x10(9)/l and 100x10(9)/l were achieved in a median time of 23 (range 19-25) and 33 (range 28-39) days, respectively. Fever more than 38.5 degrees C was observed in 18 of 23 patients (78.2%), 13 had fever of unknown origin, and 5 had documented infections. Nonhematological side effects, consisting mainly of mucositis (18/23 or 78.2%) and transient liver toxicity increase (10/23 or 43.4%), were generally tolerated. All nine patients who achieved CR received a second course with FLAG-IDA, and seven patients underwent allogeneic stem cell transplantation (four from a matched donor, one from a mismatched donor, and two from an unrelated donor), while two did not reach that stage due to early relapse from CR. The median overall survival (OS) for all 23 patients was 4.5 (range 1-38) months; for the nine responders, the disease-free survival (DFS) and the OS were 6 (range 3-38) and 9 (7-38) months, respectively; the seven patients who received allogeneic stem cell transplantation had a DFS of 10 (range 7-38) months. In our experience, FLAG-IDA is a well-tolerated regimen in relapsed/refractory ALL patients; the toxicity is acceptable, enabling patients who have achieved CR to receive allogeneic transplantation.

Authors+Show Affiliations

Hematology Section, DIMIMP Department, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy. g.specchia@ematba.uniba.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16047203

Citation

Specchia, G, et al. "FLAG-IDA in the Treatment of Refractory/relapsed Adult Acute Lymphoblastic Leukemia." Annals of Hematology, vol. 84, no. 12, 2005, pp. 792-5.
Specchia G, Pastore D, Carluccio P, et al. FLAG-IDA in the treatment of refractory/relapsed adult acute lymphoblastic leukemia. Ann Hematol. 2005;84(12):792-5.
Specchia, G., Pastore, D., Carluccio, P., Liso, A., Mestice, A., Rizzi, R., Ciuffreda, L., Pietrantuono, G., & Liso, V. (2005). FLAG-IDA in the treatment of refractory/relapsed adult acute lymphoblastic leukemia. Annals of Hematology, 84(12), 792-5.
Specchia G, et al. FLAG-IDA in the Treatment of Refractory/relapsed Adult Acute Lymphoblastic Leukemia. Ann Hematol. 2005;84(12):792-5. PubMed PMID: 16047203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - FLAG-IDA in the treatment of refractory/relapsed adult acute lymphoblastic leukemia. AU - Specchia,G, AU - Pastore,D, AU - Carluccio,P, AU - Liso,A, AU - Mestice,A, AU - Rizzi,R, AU - Ciuffreda,L, AU - Pietrantuono,G, AU - Liso,V, Y1 - 2005/11/12/ PY - 2005/01/17/received PY - 2005/07/12/accepted PY - 2005/7/28/pubmed PY - 2006/3/3/medline PY - 2005/7/28/entrez SP - 792 EP - 5 JF - Annals of hematology JO - Ann Hematol VL - 84 IS - 12 N2 - Relapsed or refractory adult acute lymphoblastic leukemias (ALL) have poor prognosis. The strategy for treating these patients is through reinduction chemotherapy followed by allogeneic stem cell transplantation, provided that the toxicity of the salvage regimen is acceptable. Twenty three patients with relapsed/refractory adult ALL were treated with fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin (FLAG-IDA). Five patients had primary refractory disease, and 18 were in first relapse. Nine (39.1%) patients achieved complete remission (CR) following salvage therapy, whereas 13 (56.5%) patients were refractory, and one patient died in aplasia due to infection. In patients achieving remission, the median time to reach absolute neutrophil count (ANC) more than 0.5x10(9)/l and 1x10(9)/l was 20 (range 16-25) and 24 (range 20-28) days from the start of chemotherapy, respectively. Platelet levels of more than 20x10(9)/l and 100x10(9)/l were achieved in a median time of 23 (range 19-25) and 33 (range 28-39) days, respectively. Fever more than 38.5 degrees C was observed in 18 of 23 patients (78.2%), 13 had fever of unknown origin, and 5 had documented infections. Nonhematological side effects, consisting mainly of mucositis (18/23 or 78.2%) and transient liver toxicity increase (10/23 or 43.4%), were generally tolerated. All nine patients who achieved CR received a second course with FLAG-IDA, and seven patients underwent allogeneic stem cell transplantation (four from a matched donor, one from a mismatched donor, and two from an unrelated donor), while two did not reach that stage due to early relapse from CR. The median overall survival (OS) for all 23 patients was 4.5 (range 1-38) months; for the nine responders, the disease-free survival (DFS) and the OS were 6 (range 3-38) and 9 (7-38) months, respectively; the seven patients who received allogeneic stem cell transplantation had a DFS of 10 (range 7-38) months. In our experience, FLAG-IDA is a well-tolerated regimen in relapsed/refractory ALL patients; the toxicity is acceptable, enabling patients who have achieved CR to receive allogeneic transplantation. SN - 0939-5555 UR - https://www.unboundmedicine.com/medline/citation/16047203/FLAG_IDA_in_the_treatment_of_refractory/relapsed_adult_acute_lymphoblastic_leukemia_ L2 - https://dx.doi.org/10.1007/s00277-005-1090-9 DB - PRIME DP - Unbound Medicine ER -