Effect Of Modified Flag Regimen Therapy On 33 Patients With Relapsed/Refractory Leukemia.

The hematological complete remission (CR) rate of the FLAG regimen [fludarabine and cytarabine (Ara-C) and granulocyte-colony stimulating factor] for relapsed and refractory acute non- lymphocytic leukemia (ANLL) was 50-64%. The aim of this study was to investigate the modified FLAG regimen (Ara-C reduced to 200 mg per day intravenous injection for 5 to 7 days, and the patients were not administrated G-CSF before fludarabine and Ara-C) to examine whether it can achieve the same effectiveness and minor side effects.Of 33 patients with acute leukemia, there were 16 cases with ANLL, 12 cases with refractory acute lymphocytic leukemia (ALL) and 5 cases with relapsed ALL, respectively. All patients received fludarabine (Flu) 30 mg/m(2)/d intravenous injection for 5 days. And every patient received simultaneously Flu in combination with Ara-C intravenously for 5-7 days, 18 cases with Ara-C at a dose of 200 mg per day, 5 cases with Ara-c 500 mg/d and 10 cases with Ara-c 1000 mg/d, respectively. One course consisted of 7 days. ALL patients and the patients received Ara-C at a dose of 200 mg per day were not treated with G-CSF before chemotherapy. ALL patients received vincristine at a dose of 2 mg/w for 2 times and prednisone 60-80 mg/d for 14 days. Of these 33 patients, the cases with white blood cell(WBC) counts less than 1.0 x 10(9)/L were treated with G-CSF at a dose of 300 microg/d subcutaneously until WBC counts were more than 3.0 x 10(9)/L. All patient were examined for bone marrow after every course.The CR rate of 16 patients with refractory ANLL was 56.3%, whereas the CR rate of 12 cases with refractory ALL was 17% (P< 0.01). The CR rate of the patients with refractory ANLL who received Ara-C 200 mg/d was higher than those with refractory ANLL receiving Ara-C at the medial doses (70% versus 33%, P >0.05). The average durations of WBC< 0.6 x 10(9)/L and platelet< 15.6 x 10(9)/L were 5 days and 4.3 days, respectively. Infection rate of the patients receiving Ara-C 200 mg/d was significantly lower than those receiving Ara-C at the medial doses (58% versus 87.5%,P< 0.05).The CR rate of modified FLAG regimen is higher than classic FLAG, whereas the infection rate of the former is lower than the latter.