title: Non-anthracycline based remission induction therapy for newly diagnosed patients with acute myeloid leukemia aged 60 or older.
abstract: We assessed remission rates and toxicity in 24 consecutive elderly (age>or=60) patients with untreated Acute myeloid leukemia (AML) who received the anthracycline-free combination of fludarabine, cytosine arabinoside and G-CSF (FLAG) as initial induction chemotherapy at our center. CR was achieved following one cycle of FLAG in 14 patients (58%). Another four patients cleared blasts from their bone marrow by day 30 without complete platelet recovery. Three patients died from infections prior to neutrophil recovery (12%). No other grade 3/4 toxicities and no clinically significant mucositis were seen. No significant association was found between age, WBC and cytogenetic risk group with likelihood of achieving CR. Fifteen patients proceeded to consolidation therapy and seven patients received a stem cell transplant (six autologous, one allogeneic). Primary induction with FLAG in elderly AML patients achieves a high remission rate without prohibitive mucosal or cardiac toxicity and may thus be considered as an alternative to standard anthracycline-based regimens in this setting.
authors.affiliation: Department of Medicine, University of California, San Diego, 9500 Gilman Dr, Mail Code 0960, La Jolla, CA 92093-0960, USA. abashey@ucsd.edu
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.forename: Anita
authors.initials: A
authors.lastname: Ihasz
authors.forename: Bridget
authors.initials: B
authors.lastname: Medina
authors.forename: Sue
authors.initials: S
authors.lastname: Corringham
authors.forename: Katherine
authors.initials: K
authors.lastname: Keese
authors.forename: Ewa
authors.initials: E
authors.lastname: Carrier
authors.forename: Januario E
authors.initials: JE
authors.lastname: Castro
authors.forename: Peter
authors.initials: P
authors.lastname: Holman
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Lane
authors.forename: Kamran
authors.initials: K
authors.lastname: Hassidim
authors.forename: Edward D
authors.initials: ED
authors.lastname: Ball
mesh_terms: D000208:Acute Disease; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy*; D008875:Middle Aged; D012074:Remission Induction; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D014740:Vidarabine; C024352:fludarabine