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.
UR - http://informahealthcare.com/doi/pdf/10.3109/10428194.2012.713479
U2 - 10.3109/10428194.2012.713479
DO - 10.3109/10428194.2012.713479
M3 - Article
VL - 54
SP - 336
EP - 341
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
SN - 1042-8194
IS - 2
ER -