FLAG-IDA REGIMEN AS SALVAGE THERAPY IN REFRACTORY/RELAPSED AML PATIENTS: A SINGLE-CENTER EXPERIENCE
(Abstract release date: 05/19/16)
EHA Library. Delia M. 06/09/16; 132484; E935
Dr. Mario Delia
Contributions
Contributions
Abstract
Abstract: E935
Type: Eposter Presentation
Background
Although treatment outcome in acute myeloid leukemia (AML) adult patient has improved over the past decade, relapse still occurs in up to 50-70% of cases. Furthermore, 15-30% of patients fail to achieve complete remission (CR) because of treatment-resistance. The management of primary refractory and/or relapsed disease remains challenging for clinicians. Although several different chemotherapy combinations are currently administered in refractory/relapsed AML patients, the prognosis is still poor, with a complete remission rate ranging from 30% to 40%.
Aims
In our study, we reviewed the outcome of 116 refractory and/or relapsed AML patients who underwent salvage therapy with the FLAG-Ida regimen between 2005 and 2015 at our institution. The study aim was to determine the efficacy of the FLAG-Ida regimen in order to clarify which variables (WHO PS, LDH, bone marrow, peripheral blood blasts and platelets counts, white blood cells (WBC), PMN, molecular-cytogentic risk, duration of response and relapsed or refractory disease), present before starting FLAG-Ida treatment, might have an impact both on CR and on overall survival (OS).
Methods
We analyzed 116 consecutive adult patients (56 males, 60 females; median age 48 years, range 17-72) with newly diagnosed acute myeloid leukemia refractory to standard induction regimens or relapsed after CR, who received the FLAG-Ida protocol as salvage therapy between January 2005 and December 2015. Sixty-eight of the 116 patients (58%) were in first relapse, forty-seven patients (42%) were refractory to conventional chemotherapy. Median WBC count before salvage therapy was 10.1 x109/l (range 0.56-88). Median bone marrow and peripheral blasts counts were 52 and 20%, respectively; median platelets count was 91x10e3/uL. According to the FAB classification, 14 patients had M0, 5 M1, 53 M2, 16 M4, 22 M5, 4 M6, 2 had Biphenotype Acute Leukemia. According to molecular-cytogenetic risk stratification 51(44%), 44 (38%) and 21 (18%) patients belonged to poor, intermediate and good risk group, respectively.
Results
Sixty-nine of 116 patients (59%) achieved complete remission (CR); forty-seven 41%) patients were refractory to the salvage therapy. In multivariable analysis, variables with positive impact on response rate were lower WBC counts (<10e3/uL, p=0.0047), higher platlets counts (>50x10e3/ul, p=0.046), molecular-cytogenetic risk (p=0.032), duration of response in relapsed AML (p=0.006) and relapsed rather than primary refractory disease (p=0.042), respectively. Median OS was 17 months (m). Cox regression analysis confirmed that both higher platlets counts, p=0.002 (17 (>50x10e3/ul) vs 11 m (<50x10e37uL), log Rank, p=0.05) and relapsed disease, p=0.041 (23 (relapsed) vs 17 m (refractory), Gehan-Breslow, p=0.021) correlated with better survival. Of note, molecular-cytogenetic risk evaluated before starting treatment was associated with CR, while no correlation was found with OS in multivariate model.
Conclusion
Our data seem to confirm the value of FLAG-Ida in relapsed AML rather than refractory disease, and may suggest its best usage as bridge-therapy in patients awaiting allotransplantation.
Session topic: E-poster
Keyword(s): AML, Prognostic factor, Therapy
Type: Eposter Presentation
Background
Although treatment outcome in acute myeloid leukemia (AML) adult patient has improved over the past decade, relapse still occurs in up to 50-70% of cases. Furthermore, 15-30% of patients fail to achieve complete remission (CR) because of treatment-resistance. The management of primary refractory and/or relapsed disease remains challenging for clinicians. Although several different chemotherapy combinations are currently administered in refractory/relapsed AML patients, the prognosis is still poor, with a complete remission rate ranging from 30% to 40%.
Aims
In our study, we reviewed the outcome of 116 refractory and/or relapsed AML patients who underwent salvage therapy with the FLAG-Ida regimen between 2005 and 2015 at our institution. The study aim was to determine the efficacy of the FLAG-Ida regimen in order to clarify which variables (WHO PS, LDH, bone marrow, peripheral blood blasts and platelets counts, white blood cells (WBC), PMN, molecular-cytogentic risk, duration of response and relapsed or refractory disease), present before starting FLAG-Ida treatment, might have an impact both on CR and on overall survival (OS).
Methods
We analyzed 116 consecutive adult patients (56 males, 60 females; median age 48 years, range 17-72) with newly diagnosed acute myeloid leukemia refractory to standard induction regimens or relapsed after CR, who received the FLAG-Ida protocol as salvage therapy between January 2005 and December 2015. Sixty-eight of the 116 patients (58%) were in first relapse, forty-seven patients (42%) were refractory to conventional chemotherapy. Median WBC count before salvage therapy was 10.1 x109/l (range 0.56-88). Median bone marrow and peripheral blasts counts were 52 and 20%, respectively; median platelets count was 91x10e3/uL. According to the FAB classification, 14 patients had M0, 5 M1, 53 M2, 16 M4, 22 M5, 4 M6, 2 had Biphenotype Acute Leukemia. According to molecular-cytogenetic risk stratification 51(44%), 44 (38%) and 21 (18%) patients belonged to poor, intermediate and good risk group, respectively.
Results
Sixty-nine of 116 patients (59%) achieved complete remission (CR); forty-seven 41%) patients were refractory to the salvage therapy. In multivariable analysis, variables with positive impact on response rate were lower WBC counts (<10e3/uL, p=0.0047), higher platlets counts (>50x10e3/ul, p=0.046), molecular-cytogenetic risk (p=0.032), duration of response in relapsed AML (p=0.006) and relapsed rather than primary refractory disease (p=0.042), respectively. Median OS was 17 months (m). Cox regression analysis confirmed that both higher platlets counts, p=0.002 (17 (>50x10e3/ul) vs 11 m (<50x10e37uL), log Rank, p=0.05) and relapsed disease, p=0.041 (23 (relapsed) vs 17 m (refractory), Gehan-Breslow, p=0.021) correlated with better survival. Of note, molecular-cytogenetic risk evaluated before starting treatment was associated with CR, while no correlation was found with OS in multivariate model.
Conclusion
Our data seem to confirm the value of FLAG-Ida in relapsed AML rather than refractory disease, and may suggest its best usage as bridge-therapy in patients awaiting allotransplantation.
Session topic: E-poster
Keyword(s): AML, Prognostic factor, Therapy
Abstract: E935
Type: Eposter Presentation
Background
Although treatment outcome in acute myeloid leukemia (AML) adult patient has improved over the past decade, relapse still occurs in up to 50-70% of cases. Furthermore, 15-30% of patients fail to achieve complete remission (CR) because of treatment-resistance. The management of primary refractory and/or relapsed disease remains challenging for clinicians. Although several different chemotherapy combinations are currently administered in refractory/relapsed AML patients, the prognosis is still poor, with a complete remission rate ranging from 30% to 40%.
Aims
In our study, we reviewed the outcome of 116 refractory and/or relapsed AML patients who underwent salvage therapy with the FLAG-Ida regimen between 2005 and 2015 at our institution. The study aim was to determine the efficacy of the FLAG-Ida regimen in order to clarify which variables (WHO PS, LDH, bone marrow, peripheral blood blasts and platelets counts, white blood cells (WBC), PMN, molecular-cytogentic risk, duration of response and relapsed or refractory disease), present before starting FLAG-Ida treatment, might have an impact both on CR and on overall survival (OS).
Methods
We analyzed 116 consecutive adult patients (56 males, 60 females; median age 48 years, range 17-72) with newly diagnosed acute myeloid leukemia refractory to standard induction regimens or relapsed after CR, who received the FLAG-Ida protocol as salvage therapy between January 2005 and December 2015. Sixty-eight of the 116 patients (58%) were in first relapse, forty-seven patients (42%) were refractory to conventional chemotherapy. Median WBC count before salvage therapy was 10.1 x109/l (range 0.56-88). Median bone marrow and peripheral blasts counts were 52 and 20%, respectively; median platelets count was 91x10e3/uL. According to the FAB classification, 14 patients had M0, 5 M1, 53 M2, 16 M4, 22 M5, 4 M6, 2 had Biphenotype Acute Leukemia. According to molecular-cytogenetic risk stratification 51(44%), 44 (38%) and 21 (18%) patients belonged to poor, intermediate and good risk group, respectively.
Results
Sixty-nine of 116 patients (59%) achieved complete remission (CR); forty-seven 41%) patients were refractory to the salvage therapy. In multivariable analysis, variables with positive impact on response rate were lower WBC counts (<10e3/uL, p=0.0047), higher platlets counts (>50x10e3/ul, p=0.046), molecular-cytogenetic risk (p=0.032), duration of response in relapsed AML (p=0.006) and relapsed rather than primary refractory disease (p=0.042), respectively. Median OS was 17 months (m). Cox regression analysis confirmed that both higher platlets counts, p=0.002 (17 (>50x10e3/ul) vs 11 m (<50x10e37uL), log Rank, p=0.05) and relapsed disease, p=0.041 (23 (relapsed) vs 17 m (refractory), Gehan-Breslow, p=0.021) correlated with better survival. Of note, molecular-cytogenetic risk evaluated before starting treatment was associated with CR, while no correlation was found with OS in multivariate model.
Conclusion
Our data seem to confirm the value of FLAG-Ida in relapsed AML rather than refractory disease, and may suggest its best usage as bridge-therapy in patients awaiting allotransplantation.
Session topic: E-poster
Keyword(s): AML, Prognostic factor, Therapy
Type: Eposter Presentation
Background
Although treatment outcome in acute myeloid leukemia (AML) adult patient has improved over the past decade, relapse still occurs in up to 50-70% of cases. Furthermore, 15-30% of patients fail to achieve complete remission (CR) because of treatment-resistance. The management of primary refractory and/or relapsed disease remains challenging for clinicians. Although several different chemotherapy combinations are currently administered in refractory/relapsed AML patients, the prognosis is still poor, with a complete remission rate ranging from 30% to 40%.
Aims
In our study, we reviewed the outcome of 116 refractory and/or relapsed AML patients who underwent salvage therapy with the FLAG-Ida regimen between 2005 and 2015 at our institution. The study aim was to determine the efficacy of the FLAG-Ida regimen in order to clarify which variables (WHO PS, LDH, bone marrow, peripheral blood blasts and platelets counts, white blood cells (WBC), PMN, molecular-cytogentic risk, duration of response and relapsed or refractory disease), present before starting FLAG-Ida treatment, might have an impact both on CR and on overall survival (OS).
Methods
We analyzed 116 consecutive adult patients (56 males, 60 females; median age 48 years, range 17-72) with newly diagnosed acute myeloid leukemia refractory to standard induction regimens or relapsed after CR, who received the FLAG-Ida protocol as salvage therapy between January 2005 and December 2015. Sixty-eight of the 116 patients (58%) were in first relapse, forty-seven patients (42%) were refractory to conventional chemotherapy. Median WBC count before salvage therapy was 10.1 x109/l (range 0.56-88). Median bone marrow and peripheral blasts counts were 52 and 20%, respectively; median platelets count was 91x10e3/uL. According to the FAB classification, 14 patients had M0, 5 M1, 53 M2, 16 M4, 22 M5, 4 M6, 2 had Biphenotype Acute Leukemia. According to molecular-cytogenetic risk stratification 51(44%), 44 (38%) and 21 (18%) patients belonged to poor, intermediate and good risk group, respectively.
Results
Sixty-nine of 116 patients (59%) achieved complete remission (CR); forty-seven 41%) patients were refractory to the salvage therapy. In multivariable analysis, variables with positive impact on response rate were lower WBC counts (<10e3/uL, p=0.0047), higher platlets counts (>50x10e3/ul, p=0.046), molecular-cytogenetic risk (p=0.032), duration of response in relapsed AML (p=0.006) and relapsed rather than primary refractory disease (p=0.042), respectively. Median OS was 17 months (m). Cox regression analysis confirmed that both higher platlets counts, p=0.002 (17 (>50x10e3/ul) vs 11 m (<50x10e37uL), log Rank, p=0.05) and relapsed disease, p=0.041 (23 (relapsed) vs 17 m (refractory), Gehan-Breslow, p=0.021) correlated with better survival. Of note, molecular-cytogenetic risk evaluated before starting treatment was associated with CR, while no correlation was found with OS in multivariate model.
Conclusion
Our data seem to confirm the value of FLAG-Ida in relapsed AML rather than refractory disease, and may suggest its best usage as bridge-therapy in patients awaiting allotransplantation.
Session topic: E-poster
Keyword(s): AML, Prognostic factor, Therapy
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