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. 2022 Sep;148(9):2539-2548.
doi: 10.1007/s00432-021-03821-1. Epub 2021 Oct 5.

Outcome of patients with relapsed or refractory acute myeloid leukemia treated with Mito-FLAG salvage chemotherapy

Regina Mühleck  1 , Sebastian Scholl  1 , Inken Hilgendorf  1 , Karin Schrenk  1 , Jakob Hammersen  1 , Jochen J Frietsch  1 , Maximilian Fleischmann  1 , Herbert G Sayer  2 , Anita Glaser  3 , Andreas Hochhaus  1 , Ulf Schnetzke  4
Affiliations

Outcome of patients with relapsed or refractory acute myeloid leukemia treated with Mito-FLAG salvage chemotherapy

Regina Mühleck et al. J Cancer Res Clin Oncol. 2022 Sep.

Abstract

Purpose: Curative intended treatment is challenging in patients with relapsed or refractory acute myeloid leukemia (r/r AML) and associated with a dismal prognosis for long-term survival. Despite novel treatment options, the majority of patients are treated with chemotherapy-based regimens. Although widely used, little data exist on the combination of fludarabine, cytarabine, granulocyte colony stimulating factor (FLAG) and mitoxantrone as salvage strategy for r/r AML.

Materials and methods: Sixty-six patients receiving Mito-FLAG for r/r AML treated at a German tertiary care center between 2009 and 2019 were analyzed with regard to response rates, survival and safety profile.

Results: Overall response rate was 75.8% with 56.1% of patients achieving complete remission (CR) and 19.7% partial remission (PR). After a median follow-up of 54 months, median overall survival (OS) was 13 months. Patients transitioned to allogeneic hematopoietic stem cell transplantation (alloHSCT) (75.8%) showed a significant improvement in OS with a median OS of 17 (95% CI 8.5-25.4) months vs 3 (95% CI 1.7-4.3) months (p < 0.001). 30- and 60-day mortality rates for all patients after the initial cycle of Mito-FLAG were 4.5% and 7.6%, respectively.

Conclusion: The Mito-FLAG salvage protocol represents an effective and feasible treatment regimen for r/r AML. Importantly, a high rate of transition to successful alloHSCT with the aim of long-term disease-free survival has been shown.

Keywords: AML; Mito-FLAG; Refractory; Relapse; Salvage therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
CONSORT diagram, antileukemic responses
Fig. 2
Fig. 2
Impact of patient/disease characteristics on achieving complete remission following Mito-FLAG. Impact of different independent variables on achieving complete remission calculated by logistic regression
Fig. 3
Fig. 3
OS and EFS of the whole cohort (A–C) or alloHSCT patients (D) showing months from start of Mito-FLAG
Fig. 4
Fig. 4
OS (A) and EFS (B) of Mito-FLAG and hAC cohort
See this image and copyright information in PMC

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