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Fludarabine, High Dose Cytarabine and Granulocyte Colony-Stimulating Factor (FLAG) as Consolidation Chemotherapy in Older Patients with Acute Myeloid Leukemia: A Retrospective Cohort Study

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Abstract

The study aimed to investigate the effect of consolidation treatment with fludarabine, high-dose cytarabine and granulocyte colony-stimulating factor or FLAG in older AML patients. The study included 41 eligible patients above 54 years old, who received both induction and consolidation chemotherapy for AML from 2008 to 2013. The study cohort had a minimum 24 months follow-up period. Survival analysis was carried out to assess patients’ overall survival and disease free survival based on types of consolidation regimens. The consolidation treatment with FLAG exerted a protective effect to both overall survival and disease free survival in older patients. Patients who were consolidated with FLAG regimen had a significant longer overall survival (log-rank, p = 0.0025) and disease free survival (log-rank, p = 0.0026). The median overall survival was longer (18.70 months) with the use of FLAG when compared to non-FLAG group (8.09 months). The median disease free survival was also longer (13.84 months) with use of FLAG when compared to the non-FLAG group (4.44 months). Regression analysis with Cox model yielded hazard ratio of 0.245 (p = 0.0094) in overall survival and 0.217 (p = 0.0068) in disease free survival. The use of FLAG as consolidation treatment was associated with approximately 60–80% reduction in hazard rates. The result was adjusted for age, race and gender in regression analysis. Older AML patients had longer remission and survival when consolidated with FLAG regimen after the induction chemotherapy.

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Acknowledgements

The research was supported by Department of Hematology, Ampang Hospital, Clinical Research Centre, Ministry of Health and Institute of Mathematical Sciences, Faculty of Science, University of Malaya. We would also like to thank the Director General of Health Malaysia for his permission to publish the findings.

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This study is self-funded study.

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Authors and Affiliations

  1. Clinical Trial Unit, Level 7, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah, 68000, Ampang, Selangor, Malaysia

    Kian Boon Law

  2. Institute of Mathematical Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, 50603, Malaysia

    Kian Boon Law, Nor Aishah Hamzah & Kok Haur Ng

  3. Department of Hematology, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah, 68000, Ampang, Selangor, Malaysia

    Kian Meng Chang & Tee Chuan Ong

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  1. Kian Boon Law
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  2. Kian Meng Chang
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Correspondence to Kok Haur Ng.

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Law Kian Boon, Dr. Chang Kian Meng, Prof. Dr. Nor Aishah Hamzah, Dr. Ng Kok Haur and Dr. Ong Tee Chuan declare that they have no conflict of interest.

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Law, K.B., Chang, K.M., Hamzah, N.A. et al. Fludarabine, High Dose Cytarabine and Granulocyte Colony-Stimulating Factor (FLAG) as Consolidation Chemotherapy in Older Patients with Acute Myeloid Leukemia: A Retrospective Cohort Study. Indian J Hematol Blood Transfus 33, 483–491 (2017). https://doi.org/10.1007/s12288-017-0790-3

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  • DOI: https://doi.org/10.1007/s12288-017-0790-3

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