FLAG and FLAG-based regimens can also be used in cases of concomitant AML and either
acute lymphoblastic leukemia (ALL) or
lymphoma. Because fludarabine is highly active in
lymphoid malignancies, these regimens can further be used when patients have biphenotypic AML, in which cells display properties of both
myeloid and
lymphoid cells.
Intensified FLAG regimens
There are several intensified versions of the FLAG regimen in which a third chemotherapeutic agent is added.
MITO-FLAG (also called Mito-FLAG, FLAG-MITO, or FLAG-Mito) adds
mitoxantrone to the standard regimen. Mitoxantrone is a synthetic anthracycline analogue (an
anthracenedione) that, like idarubicin, can intercalate DNA and prevent cell division.[5][6]
The FLAMSA protocol is most often used as an induction part of a reduced-intensity conditioning regimen for patients eligible to undergo an
allogeneic stem cell transplant. In this setting, it is often combined with other agents, such as:
From transplant day (or Day 5 if FLAMSA is not a part of conditioning) until neutrophil recovery
References
^Visani G, Tosi P, Zinzani PL, et al. (November 1994). "FLAG (fludarabine + high-dose cytarabine + G-CSF): an effective and tolerable protocol for the treatment of 'poor risk' acute myeloid leukemias". Leukemia. 8 (11): 1842–6.
PMID7526088.
^Pastore D, Specchia G, Carluccio P, et al. (April 2003). "FLAG-IDA in the treatment of refractory/relapsed acute myeloid leukemia: single-center experience". Annals of Hematology. 82 (4): 231–5.
doi:
10.1007/s00277-003-0624-2.
PMID12707726.
S2CID7010268.
^Jackson GH (2004). "Use of fludarabine in the treatment of acute myeloid leukemia". The Hematology Journal. 5 Suppl 1: S62–7.
doi:
10.1038/sj.thj.6200392.
PMID15079154.
^Specchia G, Pastore D, Carluccio P, et al. (November 2005). "FLAG-IDA in the treatment of refractory/relapsed adult acute lymphoblastic leukemia". Annals of Hematology. 84 (12): 792–5.
doi:
10.1007/s00277-005-1090-9.
PMID16047203.
S2CID34573900.
^Hänel M, Friedrichsen K, Hänel A, et al. (August 2001). "Mito-flag as salvage therapy for relapsed and refractory acute myeloid leukemia". Onkologie. 24 (4): 356–60.
doi:
10.1159/000055107.
PMID11574763.
S2CID1423738.
^Chemnitz JM, von Lilienfeld-Toal M, Holtick U, et al. (January 2012). "Intermediate intensity conditioning regimen containing FLAMSA, treosulfan, cyclophosphamide, and ATG for allogeneic stem cell transplantation in elderly patients with relapsed or high-risk acute myeloid leukemia". Annals of Hematology. 91 (1): 47–55.
doi:
10.1007/s00277-011-1253-9.
PMID21584670.
S2CID25492905.
^Krejci M, Doubek M, Dusek J, et al. (October 2013). "Combination of fludarabine, amsacrine, and cytarabine followed by reduced-intensity conditioning and allogeneic hematopoietic stem cell transplantation in patients with high-risk acute myeloid leukemia". Annals of Hematology. 92 (10): 1397–403.
doi:
10.1007/s00277-013-1790-5.
PMID23728608.
S2CID624910.
^Boehm A, Rabitsch W, Locker GJ, et al. (June 2011). "Successful allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia during respiratory failure and invasive mechanical ventilation". Wiener Klinische Wochenschrift. 123 (11–12): 354–8.
doi:
10.1007/s00508-011-1590-7.
PMID21633813.
S2CID25079480.