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Original Article

Treatment of “Poor Risk” Acute Myeloid Leukemia with Fludarabine, Cytarabine and G-CSF (Flag Regimen): A Single Center Study

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Pages 295-303 | Received 07 Feb 2000, Published online: 01 Jul 2009

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Jiayu Huang, Ming Hong, Yu Zhu, Huihui Zhao, Xiaoyan Zhang, Yujie Wu, Yun Lian, Xiaoli Zhao, Jianyong Li & Sixuan Qian. (2018) Decitabine in combination with G-CSF, low-dose cytarabine and aclarubicin is as effective as standard dose chemotherapy in the induction treatment for patients aged from 55 to 69 years old with newly diagnosed acute myeloid leukemia. Leukemia & Lymphoma 59:11, pages 2570-2579.
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Chantal Fridle, Michael Medinger, Matthias C. Wilk, Katja Seipel, Jakob Passweg, Markus G. Manz & Thomas Pabst. (2017) Cladribine, cytarabine and idarubicin (CLA-Ida) salvage chemotherapy in relapsed acute myeloid leukemia (AML). Leukemia & Lymphoma 58:5, pages 1068-1075.
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Ming Hong, Han Zhu, Qian Sun, Yu Zhu, Yi Miao, Hui Yang, Hai-Rong Qiu, Jian-Yong Li & Si-Xuan Qian. (2020) Decitabine in combination with low-dose cytarabine, aclarubicin and G-CSF tends to improve prognosis in elderly patients with high-risk AML. Aging 12:7, pages 5792-5811.
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Irina Garmaevna Budaeva, L.L. Girshova, E.G. Ovsyannikova, E.N. Goryunova, O.V. Kulemina, D.V. Zaitsev, D.V. Motorin, R.Sh. Badaev, D.B. Zammoeva, V.V. Ivanov, K.V. Bogdanov, O.S. Pisotskaya, Yu.V. Mirolyubova, T.S. Nikulina, Yu.A. Alekseeva & A.Yu. Zaritskey. (2019) Prediction of FLAG ± Ida Regimen Efficacy in Patients with Relapsed/ Refractory Acute Myeloid Leukemia. Clinical oncohematology 12:3, pages 289-296.
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Martha Arellano & Jennifer Wilkinson Carlisle. (2018) How I treat older patients with acute myeloid leukemia. Cancer 124:12, pages 2472-2483.
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Kian Boon Law, Kian Meng Chang, Nor Aishah Hamzah, Kok Haur Ng & Tee Chuan Ong. (2017) Fludarabine, High Dose Cytarabine and Granulocyte Colony-Stimulating Factor (FLAG) as Consolidation Chemotherapy in Older Patients with Acute Myeloid Leukemia: A Retrospective Cohort Study. Indian Journal of Hematology and Blood Transfusion 33:4, pages 483-491.
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Hyunkyung Park, Jeonghwan Youk, Inho Kim, Sung-Soo Yoon, Seonyang Park, Jeong-Ok Lee, Soo-Mee Bang & Youngil Koh. (2016) Comparison of cladribine- and fludarabine-based induction chemotherapy in relapsed or refractory acute myeloid leukaemia. Annals of Hematology 95:11, pages 1777-1786.
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I De Kouchkovsky & M Abdul-Hay. (2016) ‘Acute myeloid leukemia: a comprehensive review and 2016 update’. Blood Cancer Journal 6:7, pages e441-e441.
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Shuning Wei, Yingchang Mi, Hui Wei, Dong Lin, Kanqi Liu, Benfa Gong, Guangji Zhang, Yuntao Liu, Yan Li, Chunlin Zhou, Bingcheng Liu, Wei Li & Jianxiang Wang. (2015) Cyclophosphamide combined with mitoxantrone and cytarabine is an effective salvage regimen for patients with acute myeloid leukemia who experienced primary induction failure or relapse. Molecular and Clinical Oncology.
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Sheng Luo. (2013) Clinical study of Mito-FLAG regimen in treatment of relapsed acute myeloid leukemia. Experimental and Therapeutic Medicine.
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Pamela S. Becker, Hagop M. Kantarjian, Frederick R. Appelbaum, Stephen H. Petersdorf, Barry Storer, Sherry Pierce, Jianqin Shan, Paul C. Hendrie, John M. Pagel, Andrei R. Shustov, Derek L. Stirewalt, Stephan Faderl, Elizabeth Harrington & Elihu H. Estey. (2011) Clofarabine with high dose cytarabine and granulocyte colony-stimulating factor (G-CSF) priming for relapsed and refractory acute myeloid leukaemia. British Journal of Haematology 155:2, pages 182-189.
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L. Melillo, D. Valente, G. D'Arena, M. Dell'Olio, A. Falcone, M.M. Minervini, M. Nobile, G. Rossi, G. Sanpaolo, P.R. Scalzulli & N. Cascavilla. (2011) Combination Treatment of Flag with Non-Pegylated Liposomal Doxorubicin (MYOCET™) in Elderly Patients with Acute Myeloid Leukemia: A Single Center Experience. International Journal of Immunopathology and Pharmacology 24:3, pages 703-709.
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Ewa Lech-Maranda, Marek Seweryn, Sebastian Giebel, Jerzy Holowiecki, Beata Piatkowska-Jakubas, Joanna Wegrzyn, Aleksander Skotnicki, Marek Kielbinski, Kazimierz Kuliczkowski, Monika Paluszewska, Wieslaw Wiktor Jedrzejczak, Magdalena Dutka, Andrzej Hellmann, Marcin Flont, Barbara Zdziarska, Grazyna Palynyczko, Lech Konopka, Tomasz Szpila, Krzysztof Gawronski, Kazimierz Sulek, Jaroslaw Sokolowski, Janusz Kloczko, Krzysztof Warzocha & Tadeusz Robak. (2010) Infectious complications in patients with acute myeloid leukemia treated according to the protocol with daunorubicin and cytarabine with or without addition of cladribine. A multicenter study by the Polish Adult Leukemia Group (PALG). International Journal of Infectious Diseases 14:2, pages e132-e140.
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Marco Montillo, Francesca Ricci, Alessandra Tedeschi, Anna Maria Cafro, Anna Maria Nosari, Michele Nichelatti, Laura Marbello & Enrica Morra. (2009) Twice daily fludarabine/Ara-C associated to idarubicin, G-CSF and ATRA is an effective salvage regimen in non-promyelocytic acute myeloid leukemia. Leukemia Research 33:8, pages 1072-1078.
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Andrea Camera, Ciro R. Rinaldi, Salvatore Palmieri, Nicola Cantore, Giuseppina Mele, Vincenzo Mettivier, Eustachio Miraglia, Lucia Mastrullo, Francesco Grimaldi, Luigia Luciano, Anna Guerriero, Bruno Rotoli & Felicetto Ferrara. (2008) Sequential continuous infusion of fludarabine and cytarabine associated with liposomal daunorubicin (DaunoXome®) (FLAD) in primary refractory or relapsed adult acute myeloid leukemia patients. Annals of Hematology 88:2, pages 151-158.
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Se Ryeon LeeDeok Hwan YangJae Sook AhnYeo Kyeoung KimJe Jung LeeYoung Jin ChoiHo Jin ShinJoo Seop ChungYoon Young ChoYee Soo ChaeJong Gwang KimSang Kyun SohnHyeoung Joon Kim. (2009) The Clinical Outcome of FLAG Chemotherapy without Idarubicin in Patients with Relapsed or Refractory Acute Myeloid Leukemia. Journal of Korean Medical Science 24:3, pages 498.
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Tadeusz Robak & Agnieszka Wierzbowska. (2009) Current and emerging therapies for acute myeloid leukemia. Clinical Therapeutics 31, pages 2349-2370.
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Agnieszka Wierzbowska, Tadeusz Robak, Agnieszka Pluta, Ewa Wawrzyniak, Barbara Cebula, Jerzy Hołowiecki, Sławomira Kyrcz-Krzemień, Sebastian Grosicki, Sebastian Giebel, Aleksander B. Skotnicki, Beata Piątkowska-Jakubas, Kazimierz Kuliczkowski, Marek Kiełbiński, Krystyna Zawilska, Janusz Kłoczko & Agata Wrzesień-Kuś. (2007) Cladribine combined with high doses of arabinoside cytosine, mitoxantrone, and G-CSF (CLAG-M) is a highly effective salvage regimen in patients with refractory and relapsed acute myeloid leukemia of the poor risk: a final report of the Polish Adult Leukem. European Journal of Haematology 80:2, pages 115-126.
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David P. Steensma & John M. Bennett. (2006) The Myelodysplastic Syndromes: Diagnosis and Treatment. Mayo Clinic Proceedings 81:1, pages 104-130.
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J. Holowiecki, S. Grosicki, M. Sadus-Wojciechowska, L. Kachel, A. Hellmann, A. Mital, A.B. Skotnicki, B. Piatkowska-Jakubas, W.W. Jedrzejczak, M. Paluszewska, M. Wach, B. Marianska, A. Wrzesien-Kus, M. Krawczyk-Kulis & J. Wojnar. (2005) Addition of Cladribine to Induction/Consolidation Regimen Does Not Impair Peripheral Blood Stem Cell Mobilization and Bone Marrow Harvest for Autotransplantation in Acute Myeloid Leukemia Patients. Transplantation Proceedings 37:10, pages 4482-4487.
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C Löfgren, F Albertioni & C Paul. (2005) High Activity and Incomplete Cross Resistance of Nucleoside Analogues Cladribine and Fludarabine Versus Ara-C on Leukemic Cells From Patients With AML. Therapeutic Drug Monitoring 27:5, pages 641-646.
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A. Wrzesień-Kuś, T. Robak, A. Wierzbowska, E. Lech-Marańda, A. Pluta, E. Wawrzyniak, A. Krawczyńska, K. Kuliczkowski, G. Mazur, M. Kiebiński, A. Dmoszyńska, M. Wach, A. Hellmann, W. Baran, J. Hołowiecki, S. Kyrcz-Krzemień & S. Grosicki. (2005) A multicenter, open, noncomparative, phase II study of the combination of cladribine (2-chlorodeoxyadenosine), cytarabine, granulocyte colony-stimulating factor and mitoxantrone as induction therapy in refractory acute myeloid leukemia: a report of the Polish Adult Leukemia Group. Annals of Hematology 84:9, pages 557-564.
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Gunnar Juliusson, Martin Höglund, Karin Karlsson, Christina Löfgren, Lars Möllgård, Christer Paul, Ulf Tidefelt & Magnus Björkholm. (2003) Increased remissions from one course for intermediate-dose cytosine arabinoside and idarubicin in elderly acute myeloid leukaemia when combined with cladribine. A randomized population-based phase II study. British Journal of Haematology 123:5, pages 810-818.
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A. Wrzesień-Kuś, T. Robak, E. Lech-Marańda, A. Wierzbowska, A. Dmoszyńska, M. Kowal, J. Hołowiecki, S. Kyrcz-Krzemień, S. Grosicki, S. Maj, A. Hellmann, A. Skotnicki, W. Je˛drzejczak & K. Kuliczkowski. (2003) A multicenter, open, non-comparative, phase II study of the combination of cladribine (2-chlorodeoxyadenosine), cytarabine, and G-CSF as induction therapy in refractory acute myeloid leukemia - a report of the Polish Adult Leukemia Group (PALG). European Journal of Haematology 71:3, pages 155-162.
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David P Steensma & Ayalew Tefferi. (2003) The myelodysplastic syndrome(s): a perspective and review highlighting current controversies. Leukemia Research 27:2, pages 95-120.
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Felicetto FerraraAdriano VendittiAngelo Michele CarellajrNicola Cantore, Francesco BuccisanoAnna TamburiniSalvatore PalmieriGiuseppina MeleMario AnnunziataMichele Mario GrecoSergio Amadori. (2002) Autologous stem‐cell transplantation for patients with acute myeloid leukemia aged over 60 yr. European Journal of Haematology 69:4, pages 200-204.
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