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- Juan M Bergua, Pau Montesinos, David Martinez-Cuadrón, Pascual Fernández-Abellán, Josefina Serrano, María J Sayas, Julio Prieto-Fernandez, Raimundo García, Ana J García-Huerta, Manuel Barrios, Celina Benavente, Manuel Pérez-Encinas, Adriana Simiele, Gabriela Rodríguez-Macias, Pilar Herrera-Puente, Rebeca Rodríguez-Veiga, María P Martínez-Sánchez, María L Amador-Barciela, Rosalía Riaza-Grau, Miguel A Sanz, and PETHEMA group.
- Department of Haematology, Hospital San Pedro de Alcántara, Cáceres, Spain.
- Br. J. Haematol. 2016 Sep 1; 174 (5): 700-10.
AbstractThe combination of fludarabine, cytarabine, idarubicin, and granulocyte colony-stimulating factor (FLAG-Ida) is widely used in relapsed/refractory acute myeloid leukaemia (AML). We retrospectively analysed the results of 259 adult AML patients treated as first salvage with FLAG-Ida or FLAG-Ida plus Gentuzumab-Ozogamicin (FLAGO-Ida) of the Programa Español de Tratamientos en Hematología (PETHEMA) database, developing a prognostic score system of survival in this setting (SALFLAGE score). Overall, 221 patients received FLAG-Ida and 38 FLAGO-Ida; 92 were older than 60 years. The complete remission (CR)/CR with incomplete blood count recovery (CRi) rate was 51%, with 9% of induction deaths. Three covariates were associated with lower CR/CRi: high-risk cytogenetics and t(8;21) at diagnosis, no previous allogeneic stem cell transplantation (allo-SCT) and relapse-free interval <1 year. Allo-SCT was performed in second CR in 60 patients (23%). The median overall survival (OS) of the entire cohort was 0·7 years, with 22% OS at 5-years. Four independent variables were used to construct the score: cytogenetics, FLT3-internal tandem duplication, length of relapse-free interval and previous allo-SCT. Using this stratification system, three groups were defined: favourable (26% of patients), intermediate (29%) and poor-risk (45%), with an expected 5-year OS of 52%, 26% and 7%, respectively. The SALFLAGE score discriminated a subset of patients with an acceptable long-term outcome using FLAG-Ida/FLAGO-Ida regimen. The results of this retrospective analysis should be validated in independent external cohorts.© 2016 John Wiley & Sons Ltd.
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