IDA-FLAG (IDARUBICIN, FLUDARABINE, HIGH-D OSE CYTARABINE, GRANULOCYTE-COLONY-STIMULATING FACTOR) - AN EFFECTIVE REGIMEN IN RELAPSED ACUTE MYELOGENOUS LEUKEMIA IN CHILDHOOD

Intensive chemotherapy has improved the prognosis of patients with AML . The success rate of relapse treatment correlates with the length of first remission. Thus early relapses and primarily refractory diseases have a grave prognosis. New chemotherapeutic regimens could be useful for those patients. Patients treated for newly diagnosed or relapsed AML with polychemotherapy regimen of the AML-BFM-studies containing in duction, consolidation and high-dose cytarabine combined with mitoxant rone (HAM) and relapsed within 2 up to 31 months after the first CR en tered a pilot trial, the so called IDA-FLAG regimen. This regimen incl udes G-CSF (day 0 up to ANC >1000/mu l, 400 mu g/m(2) . d), fludarabin e (day 1-4, 30 mg/m(2) . d), high-dose cytarabine (day 1-4, 2000 mg/m( 2) . d) and idarubicin (day 2-4, 12 mg/m(2) . d). 10 patients aged 1,8 to 28,1 years (mean = 9,6 years) having the first (n = 8) or second r elapse (n = 1) of AML or an acute blastcrisis of myelodysplastic syndr ome (n = 1) (FAB classification: M1/M2 = 3, M4/M5 = 5, M7 = 1, CMML = I) received 14 courses. Overall, 7 patients achieved CR with a mean du ration of 8,9 months (1-27 months), one patient showed a partial remis sion and two were nonresponders. 4 patients are in continuous CR for 7 ,5 to 22 months (mean = 13,2 months). 3 patients got a bone marrow tra nsplantation (allogenic = 2, autologous = 1) in CR following this trea tment. Toxicity was considerable, mainly bone marrow aplasia with leuc openia < 1000/mu l for 15 to 40 days (mean = 26,1 days), neutropenia < 500/mu l for 14 to 39 days (mean = 26,0 days) and thrombocytopenia < 30 000/mu l for 14 to 90 days (mean = 36,5 days). Further important si de effects were fever, mucositis and pneumonia. One patient died from an fulminant aspergillus sepsis during long-term neutropenia. The sequ ential administration of G-CSF, fludarabine, cytarabine and idarubicin is effective in treatment of relapsed AML in childhood and an advisab le option prior to allogenic or autologous bone marrow transplantation . With regard to the unfavorable prognosis of relapsed or refractory A ML the toxicity of this regimen seems acceptable.