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Comparing Induction Regimens in Favorable-Risk Patients With AML

By: Sarah Campen, PharmD
Posted: Friday, May 15, 2020

For patients with nonfavorable-risk acute myeloid leukemia (AML), the FLAG induction regimen—fludarabine, high dose cytarabine and filgrastim—with or without idarubicin (FLAG+/-Ida) appears to improve remission rates and postremission survival compared with the standard-of-care induction regimen of anthracycline and cytarabine, according to a study published in Leukemia Research. Historically, the FLAG+/-Ida regimen has had limited use as initial induction therapy and is a commonly used salvage regimen for treatment of relapse.

“Getting patients into complete remission faster with FLAG+/-Ida is translating into faster time from diagnosis to transplant, and this could be one major contributor to the improved disease-free survival and overall survival seen with [this course of treatment],” stated Asad Bashey, MD, PhD, of Northside Hospital, Atlanta, and colleagues.

In this retrospective study, the researchers analyzed data from 304 consecutive patients with AML with nonfavorable NCCN risk. They compared patients treated with FLAG+/-Ida (n = 218) with those who had received anthracycline plus cytarabine (n = 86).

Remission after one course of induction was significantly higher in patients receiving the FLAG regimen than anthracycline plus cytarabine (74 % vs. 62 %), as was the time to achieve complete remission (30 vs. 37.5 days). The time from diagnosis to transplant was shorter among patients in complete remission after FLAG+/-Ida than anthracycline plus cytarabine (115 vs. 151 days).

The 3-year postremission overall survival and disease-free survival were significantly better for patients receiving FLAG with idarubicin as well. The authors reported that toxicity rates for each regimen were comparable. “Further validation of these results in a well-designed randomized prospective trial will help define the best induction approaches for AML,” concluded the authors.

Disclosure: The authors reported no conflicts of interest.



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