Efficacy of cytarabine, aclarubicin and granulocyte colony-stimulating factor (CAG) regimen compared to FLAG regimen for adult patients with relapsed/refractory Philadelphia chromosome-negative acute lymphoblastic leukemia

In this study, we retrospectively assess the results in comparing the efficacies and toxicities of the three chemotherapy regimens: CAG (cytarabine, aclarubicin and granulocyte colony-stimulating factor (G-CSF), n = 87), HD-CAG (increasing the dose of aclarubicin in CAG regimen, n = 73), and FLAG (fludarabine, cytarabine and G-CSF, n = 41) regimens in patients with relapsed/refractory Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph−-ALL). Our study indicated that after one therapy course, the overall response (OR, complete reimssion (CR) + partial remission (PR)) rate was higher in CAG than that in FLAG regimen (55.2% vs. 31.7%, P = 0.013), while the CR (50.7% vs. 26.8%, P = 0.013) and OR (64.4% vs. 31.7%, P = 0.001) rates in HD-CAG regimen were both higher than that in FLAG regimen. Furthermore, the results were more pronounced in the subgroup of patients with T cell and refractory Ph−-ALL. There were no significant differences in CR and OR rates between the CAG and HD-CAG regimens. Meanwhile, the adverse effects of CAG regimen were less toxic than the FLAG and HD-CAG regimens. There were no statistically significant differences in overall survival rates at two years among the three groups (FLAG: 9.8% ± 4.6%, CAG: 11.8% ± 4.5%, HD-CAG: 11.1% ± 4.0%; P > 0.05). Our preliminary results indicated that CAG and HD-CAG regimens could be more effective and safer than FLAG regimen for relapsed/refractory Ph−-ALL.