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Updated: Jun 17, 2026
Comprehensive Protocol to Sample and Process Bone Marrow for Measuring Measurable Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia
Published on: March 5, 2018
[FLAG regimen as consolidation therapy for patients with acute myeloid leukemia]
Si-Xuan Qian1, Han-Xin Wu, Ming Hong
1Department of Hematology, The First Affiliated Hospital, Nanjing Medical University, Jiangsu Province People Hospital, Nanjing 210029, Jiansu Province, China.
The objective of study was to primarily explore the efficacy of combination of high doses cytarabine, fludarabine and G-CSF (FLAG) as the consolidation therapy for patients with acute myeloid leukemia (AML), and to analyze the influence of FLAG on peripheral stem cell mobilization. 31 patients with AML in complete remission were divided into two groups based on induction regimens, e.g. IA group (idarubicin and cytarabine) and non-IA group. All patients were consolidated with FLAG regimen which including fludarabine 50 mg/d, days 1-5; Ara-C 2 g/(m(2).d), days 1-5; G-CSF 300 microg/d. Time of its use sustained from day 0 until absolute neutrophil count > 1.0 x 10(9)/L. 17 patients received 2 or 3 courses of FLAG regimen, and 14 patients took 1 course. 9 patients received 2 courses of FLAG regimen as consolidation therapy, and then peripheral stem cells were collected from them. The results showed that sufficient peripheral stem cells were obtained in 7 out of 9 patients (77.8%) after 2 courses of FLAG regimen, however one patient failed to obtain sufficient CD34(+) cells after 3 courses. 6 patients received autologous stem cell transplantation, 3 patients received allogeneic stem cell transplantation, and 7 cases received 2 courses of Ara-c after treating with mitoxantrone or daunorubicin. One patient died within 4 weeks. 9 patients relapsed. The median survival duration was 14 (1 - 46) months and median disease-free survival time was 12 (2 - 45) months. There was no significant difference for OS and DFS between IA and non-IA groups. Myelosuppression and infections due to neutropenia were the most frequent adverse effects, severe nonhematologic toxicities were not observed in all patients. It is concluded that as consolidation regimen, the FLAG is an effective and well-tolerated treatment in AML with acceptable toxicity, and may not influence the peripheral stem cell mobilization for autologous stem cell transplantation after 2 courses of FLAG.
The objective of study was to primarily explore the efficacy of combination of high doses cytarabine, fludarabine and G-CSF (FLAG) as the consolidation therapy for patients with acute myeloid leukemia (AML), and to analyze the influence of FLAG on peripheral stem cell mobilization. 31 patients with AML in complete remission were divided into two groups based on induction regimens, e.g. IA group (idarubicin and cytarabine) and non-IA group. All patients were consolidated with FLAG regimen which including fludarabine 50 mg/d, days 1-5; Ara-C 2 g/(m(2).d), days 1-5; G-CSF 300 microg/d. Time of its use sustained from day 0 until absolute neutrophil count > 1.0 x 10(9)/L. 17 patients received 2 or 3 courses of FLAG regimen, and 14 patients took 1 course. 9 patients received 2 courses of FLAG regimen as consolidation therapy, and then peripheral stem cells were collected from them. The results showed that sufficient peripheral stem cells were obtained in 7 out of 9 patients (77.8%) after 2 courses of FLAG regimen, however one patient failed to obtain sufficient CD34(+) cells after 3 courses. 6 patients received autologous stem cell transplantation, 3 patients received allogeneic stem cell transplantation, and 7 cases received 2 courses of Ara-c after treating with mitoxantrone or daunorubicin. One patient died within 4 weeks. 9 patients relapsed. The median survival duration was 14 (1 - 46) months and median disease-free survival time was 12 (2 - 45) months. There was no significant difference for OS and DFS between IA and non-IA groups. Myelosuppression and infections due to neutropenia were the most frequent adverse effects, severe nonhematologic toxicities were not observed in all patients. It is concluded that as consolidation regimen, the FLAG is an effective and well-tolerated treatment in AML with acceptable toxicity, and may not influence the peripheral stem cell mobilization for autologous stem cell transplantation after 2 courses of FLAG.
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