Khalil Ullah Hashmi, Badshah Khan, Parvez Ahmed, Shahid Raza, Iftikhar Hussain, Ahsan Mahmood, Hamid Iqbal, Hamid Saeed Malik, Masood Anwar.
FLAG-IDA in the treatment of refractory / relapsed acute Leukemias: Single centre study.
J Pak Med Assoc Jan ;55(6):234-8.

Objective: To evaluate the efficacy and toxicity profile of the combination of fludarabine, high dose cytarabine,. idarubicin, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia, a study is being conducted at Armed Forces Bone Marrow Transplant Centre (AFBMTC) Rawalpindi since January 2003. Data up to June 2004 (early report) is being presented. Methods: Twelve Patients with refractory/relapsed (Ref/Rel) acute leukaemia (AL) were treated with fludarabine 30mg/m2 and cytosine arabinoside (AraC) Arac 2 g/m2 for 5 days, idarubicin 10mg/m2 for 3 days, and granulo cyte colony stimulating factor G-CSF 5 micro g/kg from day 0 till neutrophil recovery (ANC >1.0 x 109/I). Response was evaluated by bone marrow examination on day 20-post chemotherapy. Results: Patients included were refractory acute lymphoblastic leukaemia (ALL) (n=2), relapsed ALL (n=3), refractory acute myeloid leukaemia (AML) (n=3), secondary AML (n=2) relapsed AML (n=1) and acute undifferentiated leukaemia (AUL) (n=1). Complete remission (CR) was achieved in 8 (66.6%) patients. Three (25%) patients died of post chemotherapy complications and one patient failed to achieve remission. Out of 8 patients who achieved CR, 4 underwent allogeneic bone marrow transfusion (BMT), 1 is being evaluated for the same, I received idorubicin, AraC and etopuside (ICE) and high dose AraC, 1 did not receive further chemotherapy and 1 relapsed two months after remission. Seven patients are still in CR after a median follow up of 8 months (range 3-18). Major complications encountered were diarrhoea, mucositis, toxic ileus, transient hepatic toxicity, fungal and bacterial infections. Conclusion: In our experience, FLAG-IDA is well tolerated and effective regimen in relapsed / refractory acute leukaemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures (JPMA 55:234;2005).

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