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

Objective To investigate the efficacy and safety of fludarabine cytarabine and granulocyte colony stimulating factor (FLAG) chemotherapy on adult relapsed or refractory adult acute lymphoblastic leukemia (ALL) patients.Methods Twenty adult patients with relapsed or refractory ALL were treated with salvage therapy which was combined of fludarabine,cytarabine and granulocyte colony stimulating factor (FLAG).Another 20 cases in control group were treated with primal induction regimen and idamycin combined with etoposide and high-dose methylprednisolone.Sides effects of 2 groups were compared and FCM was used to investigate the cells with leukemia associated with immunophenotype,final comparing with bone marrow morphology.Results Hematologic toxicity was similar both in the treatment group and control group.Nonhematology complications consisted of heart and liver toxicity (1/20 and 9/20) were weaker than those in control group (4/20 and 1/20),which were mild to moderate and could be alleviated with supportive therapy.The median overall survival was no significant difference between both sides,eights patients (40.0 ％) who achieved complete remission received salvage therapy,the disease-free survival and the median overall survival were 6 months (range 4-30 months) and 11 months (range 9-30 months),respectively.Seven patients (35.0 ％) achieved complete remission in the treatment group,the disease-free survival and the median overall survival were 4 months (range 3-30 months) and 9 months (range 9-30 months) for 7 patients,respectively.In the treatment group early recurrence [5.0 ％ (1/20)] and outside marrow of recurrence rate (0)were lower than in control group [20.0 ％ (4/20) and 10.0 ％ (2/20)].Conclusion FLAG is a well-tolerated regimen for adult relapsed or refractory ALL patients which enables patients to receive allogeneic stem cell transplantation. Key words: Leukemia, lymphoblastic, acute;  Recurrence;  Refractory;  Drug therapy, combination