fludarabine + cytarabine + liposomal daunorubicin

This combination chemotherapy regimen, often referred to as FLAG-D or FLAG plus DaunoXome, consists of fludarabine, cytarabine, and liposomal daunorubicin (DaunoXome). It was specifically evaluated by the Dutch Childhood Oncology Group (DCOG) as part of the international randomized phase III trial Relapsed AML 2001/01 for the treatment of children and adolescents with relapsed or primary refractory acute myeloid leukemia (AML). The regimen typically includes G-CSF (granulocyte colony-stimulating factor) to prime leukemic blasts. Fludarabine, a purine nucleoside analog, acts synergistically by increasing the intracellular concentration of the active metabolite of cytarabine (Ara-CTP). Cytarabine is a pyrimidine analog that inhibits DNA synthesis. DaunoXome is a liposomal formulation of the anthracycline daunorubicin, which inhibits topoisomerase II and intercalates into DNA, designed to improve delivery to tumor cells and reduce cardiotoxicity. The addition of DaunoXome to the FLAG backbone demonstrated improved early treatment response and higher rates of complete remission in pediatric patients.

Brand names

DaunoXome

Other names

FLAG plus liposomal daunorubicinFLAG-D regimen