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

M Deane, M Koh, L Foroni, G Galactowicz, A V Hoffbrand, M Lawler, L Secker-Walker, H G Prentice, Mark Lawler

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

We describe a single centre experience of eight consecutive patients with relapsed or refractory Ph+ ALL treated with the FLAG/idarubicin regimen followed by BMT or PBSCT. Following FLAG/idarubicin, one achieved a partial response and seven CR. All patients subsequently received allogeneic transplants: one sibling BMT, three matched unrelated (MUD) BMT and four sibling PBSCT. Two patients received second transplants with PBSC from their original BM donors following FLA/Ida with no further conditioning. Three patients are 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 became bcr-abl negative. All eight patients had a complete cytogenetic response following transplant. Four of five assessable patients became p190 bcr-abl negative after transplant; three of these subsequently relapsed. Both patients with the p210 bcr-abl transcript remained bcr-abl positive in CR after transplant. FLAG/Ida was well tolerated and appears to be effective in inducing remission in relapsed Ph+ ALL. The use of FDR-containing chemotherapy without further conditioning prior to PBSCT deserves further study in heavily pre-treated patients and, in patients with relapsed ALL following BMT, may be a safer option than DLI (donor lymphocyte infusion) by avoiding the associated risk of aplasia.

Original languageEnglish
Pages (from-to)1137-43
Number of pages7
JournalBone Marrow Transplantation
Volume22
Issue number12
DOIs
Publication statusPublished - Dec 1998

Keywords

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols
  • Child
  • Combined Modality Therapy
  • Cytarabine
  • Female
  • Granulocyte Colony-Stimulating Factor
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Idarubicin
  • Male
  • Philadelphia Chromosome
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Remission Induction
  • Transplantation, Homologous
  • Treatment Outcome
  • Vidarabine

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