Fludarabine, cytarabine, granulocyte colony stimulating factor, +/- idarubicin (FLAG+/-Ida) is a combination chemotherapy indicated for the treatment of relapsed or refractory acute myeloid leukaemia. It is also sometimes used as the first line treatment in non-favourable risk AML.
Agents
FLAG chemotherapy regimens utilise the two antimetabolites fludarabine and ara-C (arabinofuranosyl cytidine/cytidine arabinoside), and G-CSF. Other agents may be added to this regimen; one such addition is idarubicin.
Fludarabine and myeloid leukaemia
While fludarabine does not have direct antimetabolite activity against AML, its combination with cytarabine increases the synthesis of ara-C (cytarabine-5’-triphosphate) which is active against AML.
It is often followed by two cycles of HiDAC chemotherapy consolidation.