FLAG (chemotherapy)

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FLAG is an acronym for chemotherapy regimens used for relapse and refractory acute myeloid leukemia (AML). The standard FLAG regimen consists of:

1. Fl udarabine: an inactive antimetabolite against AML, but enhances the formation of active cytarabine metabolites, fig-CTP, in AML cells;
2. High-dose cytarides ( A rabinofuranosyl cytidine, or ara-C): antimetabolites that have been shown to be most active against AML among cytotoxic drugs in a single drug trial;
3. G ranulocyte colony-stimulating factor (G-CSF): glycoproteins that shorten the duration and severity of neutropenia.

The FLAG and FLAG regimens may also be used in concurrent cases of AML and acute lymphoblastic leukemia (ALL) or lymphomas. Because fludarabine is highly active in lymphoid malignancies, this regimen may be further used when patients have biphenotypic AML, in which cells display the properties of both myeloid and lymphoid cells.

Video FLAG (chemotherapy)

Regimen FLAG yang diintensifkan

There are several versions of the enhanced FLAG regimen in which a third chemotherapeutic agent is added.

FLAG-IDA

In the FLAG-IDA regimen (also called FLAG-Ida, IDA-FLAG, or Ida-FLAG), idarubicin - anthracycline antibiotics capable of interrupting DNA and preventing cell division (mitosis) - are added to the standard FLAG regimen.

MITO-FLAG

MITO-FLAG (also called Mito-FLAG, FLAG-MITO, or FLAG-Mito) adds mitoxantrone to a standard regimen. Mitoxantrone is a synthetic anthracycline analog (antrracenedione) which, like idarubicin, can interrupt DNA and prevent cell division.

FLAMSA

FLAMSA adds amsacrine ("AMSA") to the standard FLAG regimen. (G-CSF is still included, though "G" is taken from the acronym.) Amsacrine is a highly active alkylated antineoplastic agent against AML, unlike conventional alkylators such as cyclophosphamide.

The FLAMSA protocol is most commonly used as an induction part of a low intensity conditioning regimen for patients eligible to undergo allogeneic stem cell transplantation. In this setting, it is often combined with other agents, such as:

• Cyclophosphamide (FLAMSA-CYC), and/or
• Busulfan or treosulfan (FLAMSA-BU or FLAMSA-TREO), and/or
• Melphalan (FLAMSA-MEL), and/or
• Total body irradiation, administered immediately after the end of FLAMSA to prepare the patient for transplant.

Maps FLAG (chemotherapy)

Dose

FLAG Standard

FLAG-IDA

Mito-FLAG

FLAMSA

src: www.bloodjournal.org

References

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