Efficacy
Currently, FLAG and FLAG-Ida protocols are used most commonly as salvage therapy for relapsed and refractory AML patients. There have been several studies of FLAG in this setting with reported complete response (CR) rates generally in the 50-60% range (see table below). Only the CR rates, not disease-free or overall survival, are summarised here because consolidation treatments vary significantly. In general, if induction with FLAG results in a CR, at least one further course of FLAG is recommended, followed by allogeneic transplantation if possible. Although CR rates are good, remission durations are usually short without further treatment.
Reference |
n= |
Age* (years) |
CR (%) |
TRM
(%) |
Comments |
Visani et al 1994r |
28 |
- |
58 |
7 |
- relapsed/refractory AML |
Clavio et al 1996r |
51 |
64 |
59 |
10 |
- high risk AML: MDS-AML (22), relapsed/refractory (17), poor risk (12) |
Huhmann et al 1996r |
22 |
46 |
50 |
5 |
- relapsed/refractory AML |
Nokes et al 1997r |
31 |
- |
66 |
13 |
- relapsed/refractory AML (19/4) & MDS (8) |
Montillo et al 1998r |
38 |
41 |
55 |
10 |
- relapsed/refractory AML |
Carella et al 2001r |
41 |
52 |
56 |
7 |
- relapsed/refractory AML |
Jackson et al 2001r |
21
44 |
48
47 |
81
30 |
18 |
- Group 1 = late relapse (>6 months) AML
- Group 2 = early relapse or refractory AML |
Thomas et al 2003r |
177 |
49-56 |
19-35 |
9-19 |
- 3 different FLAG variations, used sequentially in relapsed AML patients |
Lee et al 2009r |
61 |
33 |
48 |
11 |
- relapsed/refractory AML |
* Median age in years; CR = complete remission; TRM = treatment related mortality; AML = acute myeloid leukaemia; MDS = myelodysplastic syndrome