Early allogeneic transplantation for refractory or relapsed acute leukaemia following remission induction with FLAG

The prognosis for patients with secondary AML, primary resistant AML or ALL and early (<12 months) relapse of acute leukaemia remains extremely poor w ith conventional chemotherapy. As part of a strategy to improve the outcome for these patients we have treated 22 consecutive patients (18 AML, four A LL, median age 35 years) with either primary resistant disease (n=3), early relapsed leukaemia (n=12) or secondary AML (n=7, four RAEBt, two antecedan t ALL and one antecedant Hodgkin's disease) with 'FLAG' induction chemother apy with the aim of proceeding to early allogeneic transplantation either f rom sibling or unrelated donors. Eighteen patients achieved CR after one co urse of FLAG, including five patients who had documented p-glycoprotein-ind uced multidrug resistance and 10 patients with adverse cytogenetic abnormal ities. Eight patients were consolidated with a second course of FLAG prior to transplantation and so far 16 patients have undergone allogeneic transpl antation, 10 from unrelated donors and six from sibling donors (one mismatc hed). By the time of transplant three patients had progressed and were in e arly relapse and all have relapsed post BMT. Of the remaining 13 patients t ransplanted in remission, nine remain in CCR at a range of 4-26 months, thr ee have died of transplant-related complications (18%) and one patient has relapsed. We conclude that the use of FLAG induction therapy followed by ea rly allogeneic transplantation from either a sibling or unrelated donor can be an effective strategy for the treatment of this difficult group of youn g patients with poor risk acute leukaemia and appears to be associated with a low procedure-related risk.