Abstract

AIM: We evaluated the efficacy and toxicity of FLAG-IDA (fludarabine, cytarabine, idarubicine, G-CSF) salvage regimen in patients with relapsed or refractory acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML). MATERIAL AND METHOD: Relapsed/refractory ALL (n=10) and AML (n=37) patients were treated with FLAG-IDA regimen between May 2005 and April 2008. Fludarabine 30 m g/m2, cytarabine 2 gr/m2 for 5 days, idarubicine 10 mg/m2 were administered for 3 days. FINDINGS: After completion of chemotherapy G-CSF was administered 5 ug/kg/day until neutrophil recovery. There was no statistically significant difference in terms of gender, age, white blood cell count, neutrophil count, hemoglobin levels, platelet count, lactat dehidrogenase level and fibrinogen levels, PTZ, INR and aPTT levels between patients with AML and ALL. Three patients were refractory, and 7 patients were relapsed ALL. Three patients with early (42%), and 4 patients (58%) were late relapses. None of the patients with ALL achieved complete remission after FLAG-IDA regimen administration. Median survival of patients with ALL was 4.2 ± 1.6 months. Twenty patients were relapsed and 17 were refractory in AML group. Number of patients in relapsed and refractory group were similar (p=0.157). Complete remission was achieved in 15 (40.5%) cases and median duration of complete remission was 6 months. Mean overall survival was 11.64 ± 9.6 months for patients with achieved complete remission and 6.36 ± 5.9 months for patients with refractory to FLAG-IDA regimen (p=0.003). Five of seventeen (29.4%) patients with primary refractory and 10 out of 20 patients (50%) with relapsed AML achieved complete remission. Twelve out of 20 patients had early and 8 patients had late relapse. Complete remission was achieved in 4/12 (33%) in early, and 6/8 (75%) in patients with late relapse (p=0.157). There was no statistically significant difference in terms of achieving complete remission with FLAG- IDA regimen between patients with primary refractory and relapsed (p=0.09). There were no death caused from the specific toxic effect of drugs used in FLAG-IDA regimen. CONCLUSION: The remission rate in AML group with FLAG-IDA is considerable. These results suggested that FLAG- IDA therapy can be an alternative in primary refractory, early and late relapsed patients with AML, in contrast to the inefficiency in ALL cases. However, large-scale studies are warranted to determine the efficacy of FLAG-IDA in relapsed or refractory patients with ALL.