Treatment of chronic myeloid leukemia in the blastic phase with fludarabine, cytosine arabinoside and G-CSF (FLAG)

The present study was undertaken to evaluate the efficacy of the associatio n of fludarabine plus Ara-C and G-CSF (FLAG) in the treatment of 15 patient s with chronic myeloid leukemia in the blastic phase (CML-BP). Patients ach ieving a partial remission (PR) after the first course received a second FL AG. Complete remission (CR) was consolidated with another FLAG regimen. Pat ients were then submitted to an individualized program of treatment dependi ng on age and suitable donors. Overall seven patients achieved CR (46.7%), three (20%) showed a primary resistant disease, while three (20%) died duri ng remission induction therapy. Five of them received a consolidation thera py; in two cases further treatment was not performed because of severe toxi city. Median overall survival and disease-free survival were of 7.5 and 4.5 months, respectively. FLAG proved to be effective in achieving a high CR r ate in patients with CML-BP. Median overall survival and disease-free survi val were not significantly improved compared to previous studies. Neverthel ess, the treatment was well tolerated even in a group of heavily pretreated patients, allowing further transplantation opportunities in younger patien ts.