FLAG Regimen and Bortezomib: A Study of Eight Cases with Relapsed Leukaemia

Abstract

Historically, relapsed and refractory Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML) have been associated with a dismal prognosis. Relapse-refractory ALL is associated with cure rates of <10% in adults and 30% in the paediatric population. Similarly, the five-year survival rates for relapsed and refractory AML are only 10%. This case series describes eight patients with relapsed/refractory leukaemia (6 with ALL and 2 with AML) who received the FLAG-Bortezomib protocol from January 2021 to August 2022. In this case series, the authors investigated the remission rate and toxicity of the regimen, including Intensive Care Unit (ICU) admissions and the incidence of neutropenic sepsis. In the present study, the rates of culture-positive sepsis and High Dependency Unit (HDU) admission were 50% (4/8) and 37.5% (3/8), respectively, with no post-chemotherapy mortality in this cohort. Morphologic remission was documented in 87.5% (7/8) of cases, and negative minimal residual disease was achieved in 62.5% (5/8), with 100% (2/2) remission in those with AML. One patient with ALL experienced disease progression during treatment. The FLAG with Bortezomib protocol induces remission in relapsed and refractory ALL and AML patients with an acceptable toxicity profile. This protocol requires rigorous blood product support in the form of packed red blood cells, platelet-rich plasma, and single-donor platelet apheresis. It serves as a bridge to stem cell transplant.

Keywords

• acute myeloid leukaemia
• acute lymphoblastic leukaemia
• fludarabine ara-c granulocyte csf