FLAG for Relapsed ALL – pro

Patients with relapsed acute lymphoblastic leukemia (ALL) have an extremely poor prognosis. Patients with acute lymphoblastic leukemia (ALL) who experience a relapse following chemotherapy and maintenance therapy are unlikely to be cured by further chemotherapy alone. These patients should be considered for reinduction chemotherapy followed by allogeneic bone marrow transplantation. Most patients are referred for investigational therapies. Young patients who have not previously undergone transplantation are referred for such therapy. Reinduction regimens include the hyper-CVAD protocol and high-dose Ara-C–based regimens. There is no preferred protocol at this time as investigtion has not yet identified a superior regimen.

The purine nucleoside analogues (PNA), fludarabine (FA), cladribine (2-chlorodeoxyadenosine, 2-CdA) and 2′-deoxycoformycin (DCF), represent a novel group of cytotoxic agents with high activity in low-grade lymphoid malignancies. However, several investigations have revealed that these agents are active also in acute lymphoid leukemia (AML) and chronic myelogenous leukemia (CML). Synergistic interaction between FA or 2-CdA with cytarabine (Ara-C) have been demonstrated in both preclinical and clinical studies. The addition of anthracyclines such as idarubicin  to induction therapy does not appear to result in a substantial advantage in terms of CR achievement and duration but this issue remains under investigation.

G. Specchia et al,FLAG-IDA in the treatment of refractory/relapsed adult acute lymphoblastic leukemia Annals of Hematology Issue Volume 84, Number 12 / December, 2005

Paydas S, Yavuz S, Disel U.Feasibility of FLAG-IDA regimen in cases with relapsed/refractory acute leukemia cases. Ann Hematol. 2006 Jan;85(1):63.

Pui CH, Evans WE.Treatment of acute lymphoblastic leukemia.  Engl J Med. 2006 Jan 12;354(2):166-78.
Hashmi KU, Khan B, Ahmed P, Raza S, Hussain I, Mahmood A, Iqbal H, Malik HS, Anwar M.
FLAG-IDA in the treatment of refractory/relapsed acute leukaemias: single centre study.
J Pak Med Assoc. 2005 Jun;55(6):234-8.

Specchia G, Pastore D, Carluccio P, Liso A, Mestice A, Rizzi R, Ciuffreda L, Pietrantuono G, Liso V.
FLAG-IDA in the treatment of refractory/relapsed adult acute lymphoblastic leukemia. Ann Hematol. 2005 Nov;84(12):792-5.

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