FLAG is a useful regimen for poor prognosis adult myeloid leukaemias and myelodysplastic syndromes

Leuk Lymphoma. 1997 Sep;27(1-2):93-101. doi: 10.3109/10428199709068275.

Abstract

Forty patients, with mainly poor risk haematological malignancies, were given the new regimen FLAG, comprising fludarabine, arabinosyl cytosine and G-CSF. Twenty four patients had acute myeloid leukaemia (AML), 8 patients myelodysplastic syndrome (MDS) and a further 8 patients had a variety of other haematological malignancies. The response rates for 19 relapsed and 4 refractory AML patients were 68% and 100% respectively and comparable to those attained using other regimens, although the numbers are small. Of 8 patients with MDS, 7 showed some response with 4 remaining in an improved disease status 5-12 months after FLAG. Follow-up has been too short thus far to provide any survival data in both patient groups. In general, the other smaller group of 8 patients (3 transformed chronic myeloid leukaemia (CML), 3 acute lymphoblastic leukaemia (ALL), 2 granulocytic sarcoma (GS) did poorly with response shown in 1 only. The regimen was well tolerated with 4 procedure-related neutropenic deaths. The neutropenic and thrombocytopenic periods are generally short when compared with those from current protocols. The overall modest toxicity may encourage combination with other anti-leukaemic agents and be of particular use in the aged or heavily pre-treated patients. Preliminary results may favour the setting up of controlled trials to properly evaluate the benefit of FLAG.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cytarabine / administration & dosage
  • Cytarabine / adverse effects
  • Granulocyte Colony-Stimulating Factor / administration & dosage
  • Granulocyte Colony-Stimulating Factor / adverse effects
  • Humans
  • Leukemia, Myeloid, Acute / drug therapy*
  • Middle Aged
  • Myelodysplastic Syndromes / drug therapy*
  • Prognosis
  • Vidarabine / administration & dosage
  • Vidarabine / adverse effects
  • Vidarabine / analogs & derivatives

Substances

  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Vidarabine

Supplementary concepts

  • FLAG protocol