FLAG regimen in the treatment of refractory or relapsed adult acute lymphoblastic leukemia

Objective:To investigate the efficacy and safty of fludarabine,cytarabine and granulocyte colony-stimulating factor(FLAG) chemotherapy on relapsed or refractory adult acute lymphoblastic leukemia patients(ALL).Metheds: Nineteen patients with relapsed/refractory adult ALL were treated with salvage therapy which is combined of fludarabine,cytarabine and granulocyte colony-stimulating factor.Five patients had primary refractory disease,and 14 were in first relapse.Results: Eight(42.1%) patients achieved complete remission(CR) following salvage therapy,whereas 10(52.6%) patients were inefficacy,and one patient died of infection.In patients achieving CR,the median time to reach absolute neutrophil count(ANC) more than 0.5×109/L and 1×109/L was 18(range 15-24) and 21(range 19-26) days from the start of chemotherapy,respectively.Platelet levels of more than 20×109/L and 100×109/L were achieved in a median time of 22(range 17-23) and 31(range 26-36) days,respectively.Eighteen of nineteen patients(94.7%) were observed fever more than 38.5°C,10 of whom had fever of unknown origin,and 8 of whom had documented infections.The main nonhematological side effects were mucositis(16/19,84.2%) and transient liver toxicity increase(8/19 or 42.1%),but both were generally tolerated.All eight patients who achieved CR received a second course with FLAG,and four patients underwent allogeneic stem cell transplantation(three from sibling-donors,one from a irrelevent donor),while four did not reach that stage due to early relapse from CR.The median overall survival(OS) for all 19 patients was 7(range 1-36) months;for the eight responders,the disease-free survival(DFS) and the OS were 6(range 5-36) and 10(9-36) months,respectively;the four patients who received allogeneic stem cell transplantation had a DFS of 12(range 7-36) months.Conclusions: FLAG is a well-tolerated regimen in the relapsed/refractory ALL patients;the toxicity is acceptable,which enables patients who have achieved CR to receive allogeneic stem cell transplantation.