Skip to main content
Log in

FLAG vs FLAG-IDA: outcomes in relapsed/refractory acute leukemias

  • Short Communication
  • Published:
Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Background

FLAG (fludarabine, cytarabine, granulocyte colony—stimulating factor) and FLAG-IDA (idarubicin added to standard FLAG) are salvage chemotherapy regimens used for relapsed and refractory acute leukemias. The toxicity of the FLAG-IDA courses is generally more severe than for the FLAG courses, with marked neutropenia and thrombocytopenia. This study aims to compare the outcomes of both regimens in terms of morbidity, mortality and remission/transplant. No comparison has been reported so far in Pakistan or the rest of third world countries.

Methodology

This retrospective study was conducted in Hematology and Bone Marrow Transplant unit after approval from Institutional Review Board and Ethics Committee. 76 leukemic patients treated with salvage chemotherapy were included. Our endpoints for patient outcome analysis included disease remission/relapse, HSCT following remission, morbidity, mortality, progression free survival and overall survival. Kaplan Meier curves were made in SPSS for survival analysis.

Results

A total of 76 patients were included from 2015 to July 2018. 49 patients were given FLAG, and 27 were given FLAG-IDA. 31.6% in FLAG-IDA achieved complete remission (CR)/complete remission with incomplete counts (CRi). 21% in FLAG-IDA made it to Bone marrow transplant (BMT) (67% of those in CR/CRi). 41.7% in FLAG achieved CR/CRi, and 27.8% in FLAG made it to BMT (67% of those in CR/CRi). Common complications in both regimens were infection, bleeding and other complications e.g., rash, diarrhea, mucositis, etc. A statistically significant difference was found between overall survival of the two regimens, p value 0.033.

Conclusions

FLAG regimen was found superior to FLAG-IDA with better survival and subsequent transplant rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Ramos NR, Mo CC, Karp JE et al (2015) Current approaches in the treatment of relapsed and refractory acute myeloid leukemia. J Clin Med 4:665–695

    Article  CAS  Google Scholar 

  2. Einsiedel HG, von Stackelberg A, Hartmann R et al (2005) Long-term outcome in children with relapsed ALL by risk-stratified salvage therapy: results of trial acute lymphoblastic leukemia-relapse study of the Berlin-Frankfurt-Munster Group 87. J Clin Oncol 23:7942–7950

    Article  Google Scholar 

  3. Parker JE, Pagliuca A, Mijovic A et al (1997) Fludarabine, cytarabine, G-CSF and idarubicin (FLAG-IDA) for the treatment of poor-risk myelodysplastic syndromes and acute myeloid leukaemia. Br J Haematol 99:939–944

    Article  CAS  Google Scholar 

  4. Fleischhack G, Hasan C, Graf N et al (1998) IDA-FLAG (idarubicin, fludarabine, cytarabine, G-CSF), an effective remission-induction therapy for poor-prognosis AML of childhood prior to allogeneic or autologous bone marrow transplantation: experiences of a phase II trial. Br J Haematol 102:647–655

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

MAM: corresponding author, study concept and design, revising the intellectual content; MUF: manuscript writing, analysis/data interpretation, data collection; FM: data collection; DHK: biostats, data analysis; AF: data collection.

Corresponding author

Correspondence to Muhammad Ayaz Mir.

Ethics declarations

Conflict of interest

No financial conflict of interest to report by an author.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farooq, M.U., Mushtaq, F., Farooq, A. et al. FLAG vs FLAG-IDA: outcomes in relapsed/refractory acute leukemias. Cancer Chemother Pharmacol 83, 1191–1193 (2019). https://doi.org/10.1007/s00280-019-03792-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00280-019-03792-8

Keywords

Navigation