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Methods: Patients treated with FLAG+/-Ida between January 2007 and December 2010, were identified through the pharmacy electronic database. Patient demographics, response to chemotherapy, and associated toxicities were recorded and evaluated. Complete remission (CR) was determined on day 21 post-chemotherapy. Hematologic and non-hematologic toxicities were evaluated until day 30 post-chemotherapy and were graded according to the common terminology criteria for adverse events V3.0.
Results: During the study period, 24 patients with refractory/relapsed AML were identified. The median age was 33 years (range 18-56) and 79% were males. Thirteen (54.2%) patients were in first relapse, 3 (12.5%) were in second relapse, 6(25%) had primary induction failure, and 2 (8.3%) were in relapse after bone marrow transplantation. CR was achieved in 9 (37.5%) patients; 3 of those patients subsequently received allogeneic stem cell transplantation, while 6 patients relapsed (median relapse free survival was 330 days). Eleven (45.8%) patients were refractory to FLAG+/-Ida and 4 (16.7%) patients died during reinduction therapy. Recovery of neutrophils (≥500/μL) and platelets (≥100,000/μL) required a median of 18.5 and 24 days, respectively. Median overall survival was 109 days and treatment related mortality was (16.7%).The major complication associated with treatment was neutropenic fever, which was grade 3 and 4 in 19 patients and grade 5 in 4 patients. Nonhematologic complications were mainly grade 1 and 2 nausea, vomiting, and diarrhea.
Conclusion: In our center, FLAG+/-Ida regimen was associated with lower CR but similar toxicity profile to what has been previously reported. Further research is warranted to inform on the optimum regimen in this population.