title: FLANG salvage chemotherapy is an effective regimen that offers a safe bridge to transplantation for patients with relapsed or refractory acute myeloid leukemia.
abstract: The efficacy of fludarabine in combination with an intermediate dose of cytosine arabinoside, mitoxantrone, and G-CSF (FLANG; fludarabine 30 mg/m(2)/day, cytosine arabinoside 1 g/m(2)/day, mitoxantrone 10 mg/m(2)/day, and G-CSF 300 μg/day for 5 days) was evaluated in patients with refractory or relapsed acute myelogenous leukemia (AML). Between January 2004 and December 2006, 27 patients with relapsed or refractory AML were enrolled in the present study. In total, 14 patients had experienced an early relapse, 10 had experienced a late relapse, and the remaining three (11%) had developed primary refractory leukemia at the time of study entry. Most patients (n = 17, 63%) had post-transplant relapse, and 10 of them relapsed after allogeneic hematopoietic stem cell transplantation (SCT). After FLANG treatment, 15 patients (56%) achieved a complete response (CR), and three patients died during reinduction chemotherapy. After achieving a CR, eight patients received SCT (seven allogeneic (sibling = 4, unrelated = 2, and haploidentical familial = 1) and one autologous SCT), one received donor lymphocyte infusion, three received consolidation chemotherapy, and the remaining three refused further therapy. Eight patients were alive during continuous CR, with an event-free survival (EFS) rate of 30% after a median follow-up of 42.1 months. The survival outcome of patients who received SCT was remarkable (EFS of 75%). Additionally, no toxicity severe enough to preclude transplantation was evident after or during FLANG. The findings of the present study suggest that FLANG salvage chemotherapy is an effective regimen and that it offers a safe bridge to SCT. Furthermore, this regimen prompts efforts to proceed to SCT as post-remission therapy for patients in greater than first CR.
authors: Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea College of Medicine, Seoul St Mary's Hospital, #505 Banpo-Dong, Seocho-Gu, Seoul 137-701, Korea.
authors: Ki-Seong
authors: KS
authors: Eom
authors: Woo-Sung
authors: WS
authors: Min
authors: Hee-Je
authors: HJ
authors: Kim
authors: Byung-Sik
authors: BS
authors: Cho
authors: Su-Mi
authors: SM
authors: Choi
authors: Dong-Gun
authors: DG
authors: Lee
authors: Seok
authors: S
authors: Lee
authors: Chang-Ki
authors: CK
authors: Min
authors: Yoo-Jin
authors: YJ
authors: Kim
authors: Seok-Goo
authors: SG
authors: Cho
authors: Jong-Wook
authors: JW
authors: Lee
authors: Chun-Choo
authors: CC
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015331:Cohort Studies; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D008942:Mitoxantrone; D014740:Vidarabine