Fludarabine, cytarabine, granulocyte-colony stimulating factor and amsacrine: an effective salvage therapy option for acute myeloid leukemia at first relapse

Chun Yew Fong, George Grigoriadis, Jay Hocking, John Coutsouvelis, J L Muirhead, Philip Campbell, Eldho Paul, Patricia Ann Walker, Sharon Avery, Sushrut Patil, Andrew Spencer, Anthony Schwarer, Andrew Wei

Research output: Contribution to journal › Article › Research › peer-review

Abstract

Improved therapeutic options for relapsing patients with acute myeloid leukemia (AML) are urgently needed. Poor outcomes following salvage therapy have been reported in those with short initial remission duration, adverse risk karyotype, prior allograft, older age, FLT3-internal tandem duplication (ITD) AML and prior high-dose cytarabine (HiDAC) induction therapy. We present a cohort of 58 patients (aged 18 - 70) treated with fl udarabine, cytarabine, granulocyte-colony stimulating factor (G-CSF) and amsacrine (FLAG-amsacrine) as salvage chemotherapy for AML at fi rst relapse. 83 had received prior HiDAC-based therapy. The overall complete remission (CR/CR with incomplete blood count recovery [CRi]) rate was 59 , with median event-free survival (EFS) and overall survival (OS) of 6.9 and 10.6 months, respectively. FLAG-amsacrine was an eff ective bridge to allogeneic transplant with 38 successfully transplanted with excellent outcomes (median OS not reached). FLAG-amsacrine was also eff ective in elderly patients ( 60 years), with 61 achieving second remission. The regimen was well tolerated, with 30- and 42-day treatment-related mortality of 3.4 and 13.8 , respectively. Outcomes remained poor in those with short initial remission duration ( 6 months). We conclude that FLAG-amsacrine is a useful salvage option for AML at fi rst relapse.
Original languageEnglish
Pages (from-to)336 - 341
Number of pages6
JournalLeukemia and Lymphoma
Volume54
Issue number2
DOIs
Publication statusPublished - 2013

Cite this

Fong, Chun Yew ; Grigoriadis, George ; Hocking, Jay ; Coutsouvelis, John ; Muirhead, J L ; Campbell, Philip ; Paul, Eldho ; Walker, Patricia Ann ; Avery, Sharon ; Patil, Sushrut ; Spencer, Andrew ; Schwarer, Anthony ; Wei, Andrew. / Fludarabine, cytarabine, granulocyte-colony stimulating factor and amsacrine: an effective salvage therapy option for acute myeloid leukemia at first relapse. In: Leukemia and Lymphoma. 2013 ; Vol. 54, No. 2. pp. 336 - 341.
@article{1971c198608c4f1a999c41c636e269e6,
title = "Fludarabine, cytarabine, granulocyte-colony stimulating factor and amsacrine: an effective salvage therapy option for acute myeloid leukemia at first relapse",
abstract = "Improved therapeutic options for relapsing patients with acute myeloid leukemia (AML) are urgently needed. Poor outcomes following salvage therapy have been reported in those with short initial remission duration, adverse risk karyotype, prior allograft, older age, FLT3-internal tandem duplication (ITD) AML and prior high-dose cytarabine (HiDAC) induction therapy. We present a cohort of 58 patients (aged 18 - 70) treated with fl udarabine, cytarabine, granulocyte-colony stimulating factor (G-CSF) and amsacrine (FLAG-amsacrine) as salvage chemotherapy for AML at fi rst relapse. 83 had received prior HiDAC-based therapy. The overall complete remission (CR/CR with incomplete blood count recovery [CRi]) rate was 59 , with median event-free survival (EFS) and overall survival (OS) of 6.9 and 10.6 months, respectively. FLAG-amsacrine was an eff ective bridge to allogeneic transplant with 38 successfully transplanted with excellent outcomes (median OS not reached). FLAG-amsacrine was also eff ective in elderly patients ( 60 years), with 61 achieving second remission. The regimen was well tolerated, with 30- and 42-day treatment-related mortality of 3.4 and 13.8 , respectively. Outcomes remained poor in those with short initial remission duration ( 6 months). We conclude that FLAG-amsacrine is a useful salvage option for AML at fi rst relapse.",
author = "Fong, {Chun Yew} and George Grigoriadis and Jay Hocking and John Coutsouvelis and Muirhead, {J L} and Philip Campbell and Eldho Paul and Walker, {Patricia Ann} and Sharon Avery and Sushrut Patil and Andrew Spencer and Anthony Schwarer and Andrew Wei",
year = "2013",
doi = "10.3109/10428194.2012.713479",
language = "English",
volume = "54",
pages = "336 -- 341",
journal = "Leukemia and Lymphoma",
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Fong, CY, Grigoriadis, G, Hocking, J, Coutsouvelis, J, Muirhead, JL, Campbell, P, Paul, E, Walker, PA, Avery, S, Patil, S, Spencer, A, Schwarer, A & Wei, A 2013, 'Fludarabine, cytarabine, granulocyte-colony stimulating factor and amsacrine: an effective salvage therapy option for acute myeloid leukemia at first relapse' Leukemia and Lymphoma, vol. 54, no. 2, pp. 336 - 341. https://doi.org/10.3109/10428194.2012.713479

Fludarabine, cytarabine, granulocyte-colony stimulating factor and amsacrine: an effective salvage therapy option for acute myeloid leukemia at first relapse. / Fong, Chun Yew; Grigoriadis, George; Hocking, Jay; Coutsouvelis, John; Muirhead, J L; Campbell, Philip; Paul, Eldho; Walker, Patricia Ann; Avery, Sharon; Patil, Sushrut; Spencer, Andrew; Schwarer, Anthony; Wei, Andrew.

In: Leukemia and Lymphoma, Vol. 54, No. 2, 2013, p. 336 - 341.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Fludarabine, cytarabine, granulocyte-colony stimulating factor and amsacrine: an effective salvage therapy option for acute myeloid leukemia at first relapse

AU - Fong, Chun Yew

AU - Grigoriadis, George

AU - Hocking, Jay

AU - Coutsouvelis, John

AU - Muirhead, J L

AU - Campbell, Philip

AU - Paul, Eldho

AU - Walker, Patricia Ann

AU - Avery, Sharon

AU - Patil, Sushrut

AU - Spencer, Andrew

AU - Schwarer, Anthony

AU - Wei, Andrew

PY - 2013

Y1 - 2013

N2 - Improved therapeutic options for relapsing patients with acute myeloid leukemia (AML) are urgently needed. Poor outcomes following salvage therapy have been reported in those with short initial remission duration, adverse risk karyotype, prior allograft, older age, FLT3-internal tandem duplication (ITD) AML and prior high-dose cytarabine (HiDAC) induction therapy. We present a cohort of 58 patients (aged 18 - 70) treated with fl udarabine, cytarabine, granulocyte-colony stimulating factor (G-CSF) and amsacrine (FLAG-amsacrine) as salvage chemotherapy for AML at fi rst relapse. 83 had received prior HiDAC-based therapy. The overall complete remission (CR/CR with incomplete blood count recovery [CRi]) rate was 59 , with median event-free survival (EFS) and overall survival (OS) of 6.9 and 10.6 months, respectively. FLAG-amsacrine was an eff ective bridge to allogeneic transplant with 38 successfully transplanted with excellent outcomes (median OS not reached). FLAG-amsacrine was also eff ective in elderly patients ( 60 years), with 61 achieving second remission. The regimen was well tolerated, with 30- and 42-day treatment-related mortality of 3.4 and 13.8 , respectively. Outcomes remained poor in those with short initial remission duration ( 6 months). We conclude that FLAG-amsacrine is a useful salvage option for AML at fi rst relapse.

AB - Improved therapeutic options for relapsing patients with acute myeloid leukemia (AML) are urgently needed. Poor outcomes following salvage therapy have been reported in those with short initial remission duration, adverse risk karyotype, prior allograft, older age, FLT3-internal tandem duplication (ITD) AML and prior high-dose cytarabine (HiDAC) induction therapy. We present a cohort of 58 patients (aged 18 - 70) treated with fl udarabine, cytarabine, granulocyte-colony stimulating factor (G-CSF) and amsacrine (FLAG-amsacrine) as salvage chemotherapy for AML at fi rst relapse. 83 had received prior HiDAC-based therapy. The overall complete remission (CR/CR with incomplete blood count recovery [CRi]) rate was 59 , with median event-free survival (EFS) and overall survival (OS) of 6.9 and 10.6 months, respectively. FLAG-amsacrine was an eff ective bridge to allogeneic transplant with 38 successfully transplanted with excellent outcomes (median OS not reached). FLAG-amsacrine was also eff ective in elderly patients ( 60 years), with 61 achieving second remission. The regimen was well tolerated, with 30- and 42-day treatment-related mortality of 3.4 and 13.8 , respectively. Outcomes remained poor in those with short initial remission duration ( 6 months). We conclude that FLAG-amsacrine is a useful salvage option for AML at fi rst relapse.

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U2 - 10.3109/10428194.2012.713479

DO - 10.3109/10428194.2012.713479

M3 - Article

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JO - Leukemia and Lymphoma

JF - Leukemia and Lymphoma

SN - 1042-8194

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ER -

Fong CY, Grigoriadis G, Hocking J, Coutsouvelis J, Muirhead JL, Campbell P et al. Fludarabine, cytarabine, granulocyte-colony stimulating factor and amsacrine: an effective salvage therapy option for acute myeloid leukemia at first relapse. Leukemia and Lymphoma. 2013;54(2):336 - 341. https://doi.org/10.3109/10428194.2012.713479

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