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Comparative Study
. 2025 Apr;114(4):620-625.
doi: 10.1111/ejh.14370. Epub 2024 Dec 26.

Comparison of HiDAC Versus FLAG-IDA in the Treatment of Relapsed Acute Myeloid Leukemia and High-Risk Myelodysplastic Syndrome

Man Wai Tang  1 , Deborah Van der Tuin  1 , Mesire Aydin  1 , Jarom Heijmans  1 , Arjan A Van de Loosdrecht  1 , Ellen Meijer  1 , Caroline E Rutten  1 , Mariëlle Wondergem  1 , Jeroen J W M Janssen  2 , Marjolein L Donker  1 , Mette D Hazenberg  1 , Sonja Zweegman  1 , Bart J Biemond  1 , David C De Leeuw  1 , Erfan Nur  1   3
Affiliations
Comparative Study

Comparison of HiDAC Versus FLAG-IDA in the Treatment of Relapsed Acute Myeloid Leukemia and High-Risk Myelodysplastic Syndrome

Man Wai Tang et al. Eur J Haematol. 2025 Apr.

Abstract

Background: Relapsed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (HR-MDS) are associated with a poor prognosis. It is unknown which re-induction therapy provides the highest chance of durable remission. Commonly used therapies are high dose cytarabine (HiDAC) and triple therapy consisting of fludarabine, cytarabine, and idarubicin combined with granulocyte colony-stimulating factor (FLAG-IDA).

Methods: Two patient cohorts with relapsed AML or HR-MDS treated with HiDAC or FLAG-IDA between October 2015 and December 2021 in two academic hospitals in the Netherlands were retrospectively analyzed.

Results: Patients were treated with either HiDAC (n=22) or FLAG-IDA (n=25). Rates of CR (71% vs. 74%, P=0.85), 1-year OS (47% vs. 51%, P=0.99) and EFS (38% vs. 35%, P=0.71) were comparable between HiDAC and FLAG-IDA. Durations of neutropenia (median 24 days (IQR 20-26) vs. 30 days (IQR 22-39), P=0.014) and thrombocytopenia (22 days (IQR 17-26) vs. 36 days (IQR 26-53)) were significantly shorter in the HiDAC group than in the FLAG-IDA group.

Conclusion: While remission rates and survival outcomes were similar, FLAG-IDA was associated with longer periods of myelosuppression and transfusion dependency compared to HiDAC in these two cohorts. HiDAC can be considered as a salvage chemotherapyfor relapsed AML/HR-MDS based on our study.

Keywords: MDS; chemotherapy; cytarabine; leukemia; myelosuppression.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Overall survival (A) and event‐free survival (B) of HiDAC and FLAG‐IDA.
See this image and copyright information in PMC

References

    1. Arfons L. M., Tomblyn M., Rocha V., and Lazarus H. M., “Second Hematopoietic Stem Cell Transplantation in Myeloid Malignancies,” Current Opinion in Hematology 16, no. 2 (2009): 112–123. - PMC - PubMed
    1. Christopeit M., Kroger N., Haferlach T., and Bacher U., “Relapse Assessment Following Allogeneic SCT in Patients with MDS and AML,” Annals of Hematology 93, no. 7 (2014): 1097–1110. - PubMed
    1. Kindwall‐Keller T. and Isola L. M., “The Evolution of Hematopoietic SCT in Myelodysplastic Syndrome,” Bone Marrow Transplantation 43, no. 8 (2009): 597–609. - PubMed
    1. Warlick E. D., Cioc A., Defor T., Dolan M., and Weisdorf D., “Allogeneic Stem Cell Transplantation for Adults with Myelodysplastic Syndromes: Importance of Pretransplant Disease Burden,” Biology of Blood and Marrow Transplantation 15, no. 1 (2009): 30–38. - PubMed
    1. DeWolf S. and Tallman M. S., “How I treat relapsed or refractory AML,” Blood 136, no. 9 (2020): 1023–1032. - PMC - PubMed

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