Patients with non-favorable National Comprehensive Cancer Network (NCCN) risk acute myelogenous leukemia (AML) had better outcomes when treated with FLAG+/-Ida (fludarabine, high dose cytarabine and granulocyte-colony stimulating factor with or without idarubicin) as the induction regimen compared with 7+3 (cytarabine + anthracycline), showed a retrospective analysis recently published in Leukemia Research.

The retrospective analysis included 304 patients from a single center who received either FLAG+/-Ida (218 patients) or 7+3 (86 patients) as their first treatment for AML.

The analysis revealed that a significantly higher proportion of patients who received FLAG+/-Ida went into remission after 1 induction course compared with 7+3 (74% vs 62%, P <.001). Also, patients who received FLAG+/-Ida achieved a complete response (30 days vs 37.5, P<0.001) and underwent transplant (115 vs 151 days, P <.003) significantly more quickly than those who received 7+3.

Clinical outcomes were also better for patients who received FLAG+/-Ida, with these patients having significantly higher 3-year overall survival (54% vs 49%; P =.01) and disease-free survival rates (39% vs 32%; P <.01) after remission compared with 7+3.


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Choice of induction regimen (FLAG+/- Ida vs 7+3; hazard ratio [HR], 0.66; 95% CI, 0.48–0.91; P =.01), age (65 years or older vs younger than 50 years; HR, 3.14; 95% CI, 2.0 – 4.87; P<0.001), and NCCN risk (poor vs intermediate; HR, 1.90; 95% CI, 1.41–2.56; P <.001) were each associated with longer survival. Achievement of complete response was also associated with longer survival regardless of the number of days it took to achieve a response.

The study authors wrote that FLAG+/-Ida “appears” to produce better survival and improved postremission survival for AML patients with intermediate- and poor-risk AML. They encouraged further validation of these results in a “well-designed randomized prospective trial.”

Reference

Solh MM, Solomon SR, Morris LE, Zhang X, Holland HK, and Bashey A. Improved post remission survival of non-favorable risk acute myelogenous leukemia (AML) patients following initial remission induction therapy with FLAG+/-idarubicin versus 3 + 7 (anthracycline + cytarabine) [published online February 14, 2020]. Leuk Res. doi: 10.1016/j.leukres.2020.106318