ABSTRACT
Objective To observe the clinical efficacy and adverse reaction of the combination of fiudarabine,cytarabine and granulocytecolony-stimulating factor (G-CSF) (FLAG regime) therapy for refractory and relapsed acute leukemia in children. Methods From 2004 to date, a total of 9 patients with relapsed and refractory acute leukemia patients in our hospital accepted the treatment, in 9 cases 8 cases were AML,1cases were ALL; in 9 cases 5 cases were refractory acute leukemia, 4 cases were recurrent acute leukemia.Results Among the 9 cases,6 cases with 1 cycles of chemotherapy achieved complete remission (CR),CR rate was 66.7 ％ (6/9); partial remission (PR) rate was 22.2 ％ (2/9),total efficiency (CR+PR) was 88.9 ％.In 6 CR patients 2 underwent hematopoietic stem cell transplantation, are disease-free survival; this regimen' s main adverse reactions were infection,bone marrow depression and gastrointestinal reaction.Conclusion The remission rate of FLAG regimen in the treatment of children with refractory and relapsed acute leukemia is relatively high, adverse reactions were tolerable; the FLAG program is a choice for the treatment of children with refractory and relapsed acute leukemia,which provides the opportunity for subsequent hematopoietic stem cell transplantation.
ABSTRACT
Objective To primarily explore the efficacy and adverse effects of the combination of fiudarabine,cytarabine and granulocyte colony-stimulating factor(G-CSF)(FLAG regime)therapy for relapsed and refractory acute leukemia in children.Methods Ten children were treated with the FLAG regime for relapsed and refractory acute myeloid leukemia (AML)and acute lymphoblastic leukemia(ALL)from Feb.2007 to Mar.2010.There were 8 male and 2 female,with mean age 8 years(ranging from 4 to 12 years).AML was diagnosed in 8 children,AML-M2 in 5 cases,AML-M4 in 3 cases.ALL was diagnosed in 2 children,both were B-ALL.Six children had refractory disease,and 4 cases were in relapse.FLAG regime included:fludarabine 25 mg?m-2?d-1,days 1-5;cytarabine 2 g?m-2?d-1,days 1-5;G-CSF 150-300 ?g?d-1,from day 0 to neutrophils ≥0.5?109 L-1.Results Complete remission was obtained in 6 children(60%),partial remission was obtained in 1 child(10%),and 3 children were considered non-response(30%).The total effective rate was 70%.For 8 children with AML,6 children had achieved complete remission(75%),2 children had non-response(25%).While in children with ALL,1 child got partial remission,and the other one had non-response.Myelosuppression and infections due to neutropenia were the most frequent adverse effects,severe nonhematologic toxicity were not observed in these children.And there were no chemotherapy-related death.Conclusions The FLAG regime is effective in treatment of children with relapsed and refractory acute leukemia,especially for the children with the relapsed and refractory AML.The adverse effects from this regime were well tolerated.FLAG regime can give children with relapsed and refractory acute leukemia another chance.