title: FLAG (fludarabine+cytosine arabinoside+G-CSF) induces complete remission in acute-phase chronic myeloid leukaemia: a case report.
abstract: The adenine nucleoside analogue fludarabine phosphate in combination with cytosine-arabinoside (Ara-C) and granulocyte-colony stimulating factor (G-CSF) has recently proved effective in the treatment of poor-prognosis acute non-lymphoid leukaemia. We used this triple combination in a case of Ph1+ chronic myeloid leukaemia (CML) unresponsive to alpha interferon that had progressed to acute phase after 5 months of treatment with 6-mercaptopurine plus hydroxyurea. The patient was treated with four courses of fludarabine 30 mg/m2 + Ara-C 2 g/m2 (days 1-5) and G-CSF (from day 0 to polymorphonuclear (PMN) recovery). Bone marrow blasts decreased from 80% to less than 5%, and karyotyping showed a progressive clearance of Ph1+ metaphases (from 100% to 9% after the fourth course). The patient is presently receiving autologous bone marrow transplantation (ABMT). This therapeutic success in a patient for whom conventional treatment would usually be ineffective makes this combination worthy of further studies, in view of its wider use as a preparative regimen to ABMT in CML.
authors.affiliation: Istituto di Ematologia L. e A. Seràgnoli, Università di Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Visani
authors.forename: P
authors.initials: P
authors.lastname: Tosi
authors.forename: P L
authors.initials: PL
authors.lastname: Zinzani
authors.forename: S
authors.initials: S
authors.lastname: Manfroi
authors.forename: A
authors.initials: A
authors.lastname: Zaccaria
authors.forename: N
authors.initials: N
authors.lastname: Testoni
authors.forename: R M
authors.initials: RM
authors.lastname: Lemoli
authors.forename: G
authors.initials: G
authors.lastname: Rosti
authors.forename: S
authors.initials: S
authors.lastname: Pelliconi
authors.forename: S
authors.initials: S
authors.lastname: Tura
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017209:Apoptosis / Q000187:drug effects; D001853:Bone Marrow / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000473:pathology; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D014740:Vidarabine