Treatment of poor risk acute myeloid leukemia with fludarabine, cytarabine and G-CSF (FLAG regimen): A single center study

We describe a single center experience of 41 consecutive patients with poor prognosis acute myeloid leukemia (AML) who received a single course of FLAG regimen consisting of Fludarabine 30 mg/m(2)/day plus Cytarabine 2 gr/m(2)/day (days 1-5) and G-CSF 5 mg/Kg/day (from day 0 to polymorphonuclear; recovery) as salvage therapy, Eleven patients were primarily refractory to previous chemotherapy. 10 patients were in first relapse, 2 patients in second relapse and 7 patients in relapse after transplants. Eleven cases were defined as secondary AML (diagnosis of AML made after a preexisting diagnosis of myelodysplastic syndrome). The median age was 52.6 years (range 16-72):29 patients were males and 12 females. Overall. 23 (56%) patients reached complete remission (CR), 3 patients died of infection (2) or hemorrhage (l)during induction, and 15 (36%) patients had resistant disease. The highest CR rates (80%) were obtained in relapsed cases; de novo and secondary. AML registered 60% and 45% of CR rates, respectively. Patients achieving CR received a second FLAG course as consolidation and were submitted to an individualized program post-remission therapy, depending on the age and performance status. Hematological and non hematological toxicities were acceptable. In conclusion, our data confirm that FLAG is a an high effective treatment for poor prognosis AML and in young patients allows intensive post remissional therapy including allogeneic BMT.