Fludarabine, arabinosyl cytosine and Idarubian (FLAI) for remission induction in poor-risk acute myeloid leukemia

D. Russo, G. Pricolo, M. Michieli, A. Michelutti, D. Raspadori, A. Bertone, L. Marin, I. Pierri, A. Bucalossi, E. Zuffa, A. De Vivo, P. Mazza, M. Gobbi, F. Lauria, A. Zaccaria, M. Baccarani

Research output: Contribution to journalArticlepeer-review


Progress in treatment of acute myeloid leukemia (AML) is slow and treatment intensification alone has limited effects, particularly in poor-risk cases. Poor-risk cases, that are identified mainly by prior history, leukemic cell mass and cytogenetic abnormalities, share multiple mechanisms of drug resistance that are responsible for treatment failure. Since Pgp-mediated resistance to anthracycline can be reduced with Idarubicin (IDA) and resistance to arabinosyl cytosine (AC) can be reduced with Fludarabine (FLUDA), we tested a combination of high dose AC (2000 mg/sqm, 5 doses), FLUDA (30 mg/sqm, 5 doses) and IDA (12 mg/sqm, 3 doses) for remission induction and consolidation in 45 consecutive cases of poor-risk AML. The complete remission (CR) rate was 71% after the first course and 82% overall, with a projected 2-year survival and relapse-free survival of 44% and 50% respectively. Non-hematologic toxicity was very mild, that is very important in elderly patients, but hemopoietic toxicity was substantial, with a time to hematologic recovery of 3 to 4 weeks and two cases of death in CR. Peripheral blood stem cells (PBSC) could be mobilized and collected successfully only in 11 cases. This three-drug combination is effective and has a limited non-hematologic toxicity, but FLUDA may increase the difficulty of obtaining PBSC early after remission induction.

Original languageEnglish
Pages (from-to)335-343
Number of pages9
JournalLeukemia and Lymphoma
Issue number3-4
Publication statusPublished - 2001


  • Acute myeloid leukemia
  • Fludarabine
  • Idarubicin
  • Treatment

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research


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