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    FLAG is a chemotherapy regimen used for relapsed and refractory acute myeloid leukemia (AML). The acronym incorporates the three primary ingredients of the regimen:

    Fludarabine: an antimetabolite that, while not active toward AML, increases formation of an active cytarabine metabolite, ara-CTP, in AML cells;
    Arabinofuranosyl cytidine (or ara-C): an antimetabolite that has been proven to be the most active toward AML among various cytotoxic drugs in single-drug trials; and
    Granulocyte colony-stimulating factor (G-CSF): a glycoprotein that shortens the duration and severity of neutropenia.
    FLAG and FLAG-based regimens can also be used in cases of concomitant AML and either acute lymphoblastic leukemia (ALL) or lymphoma. Because fludarabine is highly active in lymphoid malignancies, these regimens can further be used when patients have biphenotypic AML, in which cells display properties of both myeloid and lymphoid cells.


    Intensified FLAG regimens


    There are several intensified versions of the FLAG regimen in which a third chemotherapeutic agent is added.


    = FLAG-IDA

    =
    In the FLAG-IDA regimen (also called FLAG-Ida, IDA-FLAG, or Ida-FLAG), idarubicin—an anthracycline antibiotic that is able to intercalate DNA and prevent cell division (mitosis)—is added to the standard FLAG regimen.


    = MITO-FLAG

    =
    MITO-FLAG (also called Mito-FLAG, FLAG-MITO, or FLAG-Mito) adds mitoxantrone to the standard regimen. Mitoxantrone is a synthetic anthracycline analogue (an anthracenedione) that, like idarubicin, can intercalate DNA and prevent cell division.


    = FLAMSA

    =
    FLAMSA adds amsacrine ("AMSA") to the standard FLAG regimen. (G-CSF is still included, even though the "G" is taken out of the acronym.) Amsacrine is an alkylating antineoplastic agent that is highly active toward AML, unlike more conventional alkylators like cyclophosphamide.
    The FLAMSA protocol is most often used as an induction part of a reduced-intensity conditioning regimen for patients eligible to undergo an allogeneic stem cell transplant. In this setting, it is often combined with other agents, such as:

    Cyclophosphamide (FLAMSA-CYC), and/or
    Busulfan or treosulfan (FLAMSA-BU or FLAMSA-TREO), and/or
    Melphalan (FLAMSA-MEL), and/or
    Total body irradiation, given shortly after the end of FLAMSA to prepare the patient for transplant.


    Dosing




    = Standard FLAG

    =


    = FLAG-IDA

    =


    = Mito-FLAG

    =


    = FLAMSA

    =


    References

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FLAG Therapeutics

FLAG Therapeutics

Pre-printed Flag Label - Caution Chemotherapy Drug

Pre-printed Flag Label - Caution Chemotherapy Drug

Chemotherapy - Fibrolamellar Cancer Foundation

Chemotherapy - Fibrolamellar Cancer Foundation

Venetoclax In Combination With FLAG-IDA Chemotherapy (FLAG-V-I) For Fit ...

Venetoclax In Combination With FLAG-IDA Chemotherapy (FLAG-V-I) For Fit ...

Pipeline Overview — FLAG Therapeutics

Pipeline Overview — FLAG Therapeutics

Chemotherapy Icon Graphic by aimagenarium · Creative Fabrica

Chemotherapy Icon Graphic by aimagenarium · Creative Fabrica

Chemotherapy - Hirshberg Foundation for Pancreatic Cancer Research

Chemotherapy - Hirshberg Foundation for Pancreatic Cancer Research

Outcomes of FLAG chemotherapy in patients with AML | Download ...

Outcomes of FLAG chemotherapy in patients with AML | Download ...

Outcomes of FLAG chemotherapy in patients with AML | Download ...

Outcomes of FLAG chemotherapy in patients with AML | Download ...

Outcomes of FLAG chemotherapy in patients with AML | Download ...

Outcomes of FLAG chemotherapy in patients with AML | Download ...

What is the regimen for FLOT chemotherapy?

What is the regimen for FLOT chemotherapy?

Chemotherapy for Skin Cancer

Chemotherapy for Skin Cancer

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FLAG (chemotherapy) - Wikipedia

FLAG is a chemotherapy regimen used for relapsed and refractory acute myeloid leukemia (AML). [1] The acronym incorporates the three primary ingredients of the regimen: Fludarabine: an antimetabolite that, while not active toward AML, increases formation of an active cytarabine metabolite, ara-CTP, in AML cells;

The FLAG Chemotherapy Regimen Is an Alternative to …

Dec 6, 2014 · The FLAG (fludarabine, cytarabine and filgrastim) regimen is a non-anthracycline based chemotherapy useful for relapsed/refractory AML and as initial therapy for “fit” eligible patients.

FLAG-IDA Regimen (Fludarabine, Cytarabine, Idarubicin and G …

Nov 16, 2007 · Objectives: Analyze the results of FLAG-IDA regimen, in terms of CR rate and long-term outcome, in a large series of patients with high-risk AML and MDS treated in a single institution.

FLAG-IDA chemotherapy for leukemia- AML | ChemoExperts

FLAG-IDA is given as induction chemotherapy to eliminate leukemia cells from the body and to decrease symptoms from AML, such as bleeding, bruising, and recurrent infections. It may be given with the goal of cure or to put the leukemia in remission so a …

Fludarabine, Cytarabine, G-CSF and Gemtuzumab Ozogamicin (FLAG …

Nov 13, 2019 · Induction consolidation with FLAG-GO results in better RFS and quantitative reduction in fusion transcript ratio, compared to FLAG-Ida. Serial quantitative monitoring of fusion transcript identifies patients with better chances of sustained remission.

The Clinical Outcome of FLAG Chemotherapy without Idarubicin …

In this study, we report the clinical effectiveness and toxicities of FLAG chemotherapy in 61 patients with relapsed or refractory AML. Sixty-one eligible patients with refractory and relapsed AML were treated with FLAG chemotherapy without idarubicin between November 2003 and September 2007.

FLAG-Ida for Acute Myeloid Leukaemia (AML)

FLAG-Ida is a combination chemotherapy regimen made up of fludarabine, high dose cytarabine (Ara-C0), idarubicin and granulocyte-colony stimulating factor (G-CSF) used in the treatment of acute myeloid leukaemia (AML).

Venetoclax Combined With FLAG-IDA Induction and …

May 27, 2021 · FLAG-IDA + VEN resulted in high rates of measurable residual disease–negative composite complete remission in patients with both ND-AML and R/R-AML, with a majority of patients able to effectively transition to allogeneic stem-cell transplantation.

FLAG (fludarabine + high-dose cytarabine + G-CSF): an ... - PubMed

Twenty-eight patients with poor prognosis acute myeloid leukemia (AML) received therapy with two courses of fludarabine 30 mg/m2/day + ara-C 2 g/m2/day (days 1-5) and G-CSF 5 mg/kg/day (FLAG) (from day 0 to polymorphonuclear recovery).

NSSG Chemotherapy Protocol

FLAG Authorised by Myeloid Lead Prof Adam Mead Nov 2021 Version 1.2 Page 1 of 4 FLAG INDICATION Induction chemotherapy for patients with acute myeloid leukaemia (AML) or in relapse/ refractory disease (AML or ALL). For patients under 60 years of age but it can be applied to older patients according to clinician's assessment. TREATMENT INTENT