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FLAG vs FLAG-IDA: outcomes in relapsed/refractory acute leukemias
Muhammad Umer Farooq1, Fahad Mushtaq1, Anum Farooq2
1Shifa College of Medicine, Islamabad, Pakistan.
Cancer Chemotherapy and Pharmacology
|March 20, 2019
Summary
The FLAG regimen demonstrated superior outcomes compared to FLAG-IDA for acute leukemia patients, showing better survival and transplant rates. This study provides crucial data for salvage chemotherapy in Pakistan.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- FLAG (fludarabine, cytarabine, granulocyte colony-stimulating factor) and FLAG-IDA (idarubicin added to FLAG) are salvage chemotherapy regimens for relapsed/refractory acute leukemias.
- FLAG-IDA is associated with more severe toxicity, including neutropenia and thrombocytopenia, compared to FLAG.
- No comparative studies on these regimens have been reported in Pakistan or other developing countries.
Purpose of the Study:
- To compare the efficacy and safety of FLAG versus FLAG-IDA salvage chemotherapy.
- To evaluate outcomes in terms of remission, transplant rates, morbidity, and mortality.
- To provide data relevant to acute leukemia treatment in resource-limited settings.
Main Methods:
- Retrospective study of 76 patients with acute leukemia treated with salvage chemotherapy.
- Analysis of endpoints including remission/relapse, HSCT, morbidity, mortality, progression-free survival, and overall survival.
- Kaplan Meier curves used for survival analysis in SPSS.
Main Results:
- 49 patients received FLAG, and 27 received FLAG-IDA.
- Complete remission (CR)/CR with incomplete counts (CRi) rates were 41.7% for FLAG and 31.6% for FLAG-IDA.
- Subsequent Bone Marrow Transplant (BMT) rates were 27.8% for FLAG and 21% for FLAG-IDA.
- A statistically significant difference in overall survival was observed (p=0.033).
Conclusions:
- The FLAG regimen was superior to FLAG-IDA, offering better survival rates.
- FLAG also demonstrated a higher subsequent transplant rate compared to FLAG-IDA.
- These findings suggest FLAG as a potentially more favorable salvage chemotherapy option in this patient population.
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