Published in:
Open Access
01-07-2018 | Research Article
Comparison of clinical remission and survival between CLAG and FLAG induction chemotherapy in patients with refractory or relapsed acute myeloid leukemia: a prospective cohort study
Authors:
Y. Bao, J. Zhao, Z.-Z. Li
Published in:
Clinical and Translational Oncology
|
Issue 7/2018
Login to get access
Abstract
Purpose
To compare the clinical remission and survival between CLAG and FLAG induction chemotherapy in treating patients with refractory or relapsed acute myeloid leukemia (R/R AML).
Methods
103 R/R AML patients were consecutively enrolled in this prospective cohort study. 55 patients were treated by CLAG induction chemotherapy as follows: 5 mg/m2/day cladribine (days 1–5); 2 g/m2/day cytarabine (days 1–5) and 300 μg/day filgrastim (days 0–5). While 48 patients were treated by FLAG: 30 mg/m2/day fludarabine (days 1–5), 2 g/m2/day cytarabine (days 1–5), and 300 μg/day filgrastim (days 0–5).
Results
CLAG induction chemotherapy achieved 61.7% complete remission rate (CR) and 78.7% overall remission rate (ORR), which was similar with FLAG chemotherapy which realized 48.7% CR and 69.2% ORR. No difference of overall survival (OS) was discovered between two groups either. Age cytarabine 60 years, secondary disease, poor risk stratification and BM blast ≥ 42.7% and second or higher salvage therapy were independent factors for worse prognosis. Subgroups analysis revealed that in patients with second or higher salvage therapy, CLAG seemed to achieve a higher CR than FLAG. And in patients with relapsed disease, poor risk stratification or CR at first induction, CLAG seemed to realize a prolonged OS compared to FLAG.
Conclusion
CLAG was equally effective to FLAG induction chemotherapy in total R/R AML patients, while CLAG seemed to be a better option than FLAG in patients with relapsed disease, poor risk stratification, CR at first induction or second or higher salvage therapies.