FLAG-idarubicin and allogeneic stem cell transplantation for Ph-positive ALL beyond first remission

We describe a single centre experience of eight consecutive patients with r elapsed or refractory Ph+ ALL treated with the FLAG/idarubicin regimen foll owed by BMT or PBSCT, Following FLAG/idarubicin, one achieved a partial res ponse and seven CR. All patients subsequently received allogeneic transplan ts: one sibling BMT, three matched unrelated (MUD) BMT and four sibling PBS CT. Two patients received second transplants with PBSC from their original BM donors following FLA/Ida with no further conditioning. Three patients ar e alive in CR 9, 24 and 32 months after transplant. Seven of eight patients had a cytogenetic response following FLAG/Ida induction and one of seven b ecame bcr-abl negative. All eight patients had a complete cytogenetic respo nse following transplant. Four of five assessable patients became p190 bcr- abl negative after transplant; three of these subsequently relapsed. Both p atients with the p210 bcr-abl transcript remained bcr-abl positive in CR af ter transplant. FLAG/Ida was well tolerated and appears to be effective in inducing remission in relapsed Ph+ ALL. The use of FDR-containing chemother apy without further conditioning prior to PBSCT deserves further study in h eavily pretreated patients and, in patients with relapsed ALL following BMT , may be a safer option than DLI (donor lymphocyte infusion) by avoiding th e associated risk of aplasia.