Volumen: 13 # Number : 2
Publication Date : Mayo - Agosto Year: 2009
Authors: Ana L Basquiera, M Virginia Prates, María Moirano, Cecilia García Erlich, Patricia Fazio, Ana G Sturich, Adriana R Berretta, M Gelemur, Jorge H Milone, Juan J García
Abstract: Background: Patients with Refractory/Relapsed (R/R)
acute leukemia (AL) have a poor prognosis. Objective: We
aimed to evaluate the chemotherapy regimen fludarabine,
cytarabine, granulocyte colony-stimulating factor,
and idarubicin (FLAG-IDA) in patients with R/R AL.
Patients: We studied 33 patients with R/R AL. Distribution
of the AL subtype was: myeloblastic n=17 (52%),
lymphoblastic n=14 (42%),) and biphenotypic n=2 (6%).
Results: Complete remission (CR) was achieved in 15
cases (45.5%) and seven patients dead resulting in a
mortality of 21.1%. In patients with hematological recovery
the median time to neutrophils recovery (> 0.5 x 109/
l) was 24 days (range 10-38); platelet levels of more than
20 x 109/l and 50 x 109/l were reached in a median time of
24 (range 17-44) and 27 days (range 18-51), respectively.
After CR, five patients underwent allogeneic transplantation
and 10 patients received a second course of FLAGIDA.
Ten out of 15 patients who achieved CR with FLAGIDA
relapsed at a median of 7.7 months (95% CI 1.8 to
13.6 months). Overall survival (OS) after FLAG-IDA in
the surviving cohort had a median of 4 months. We found
a significantly better OS in patients who received allogeneic
transplantation post-FLAG-IDA than those who
did not (median 11.4 months vs. 2.7 months; HR 0.29; 95%
CI 0.1 to 0.6; p=0.017). Conclusions: In our series, FLAGIDA
demonstrated to be an effective salvage chemotherapy
regimen, however, the benefit in survival of this
rescue treatment was restrained to patients who underwent
allogeneic transplantation.
Key words: FLAG-IDA-leukemia-relapse-survivaltransplantation
Pages : 49-52
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