A prognostic model for survival after salvage treatment with FLAG‐Ida +/− gemtuzumab‐ozogamicine in adult patients with refractory/relapsed acute myeloid leukaemia |
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Authors: | 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 the PETHEMA group |
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Affiliation: | 1. Department of Haematology, Hospital San Pedro de Alcántara, Cáceres, Spain;2. Department of Haematology, University Hospital La Fe, Valencia, Spain;3. Department of Haematology, General Hospital Alicante, Alicante, Spain;4. Department of Haematology, Hospital Reina Sofia, Córdoba, Spain;5. Department of Haematology, Hospital Doctor Peset, Valencia, Spain;6. Department of Haematology, General Hospital Castellón, Castellón, Spain;7. Department of Haematology, Central Hospital of Asturias, Oviedo, Spain;8. Department of Haematology, Hospital Carlos Haya, Málaga, Spain;9. Department of Haematology, Clinic Hospital, Madrid, Spain;10. Department of Haematology, Clinic Hospital, Santiago de Compostela, Spain;11. Department of Haematology, Hospital Povisa, Vigo, Spain;12. Department of Haematology, Hospital Gregorio Mara?on, Madrid, Spain;13. Department of Haematology, Hospital Ramón y Cajal, Madrid, Spain;14. Department of Haematology, Hospital 12 de Octubre, Madrid, Spain;15. Department of Haematology, Hospital Montecelo, Pontevedra, Spain;16. Department of Haematology, Hospital Severo Ochoa, Leganés, Spain |
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Abstract: | The 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. |
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Keywords: | relapsed‐refractory acute myeloid leukaemia salvage treatment FLAG‐Ida prognostic factors genetic risk |
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