International Journal of Hematology

, Volume 108, Issue 4, pp 390–401 | Cite as

Re-induction chemotherapy using FLAG–mitoxantrone for adult patients with relapsed acute leukemia: a single-center experience from United Arab Emirates

  • Inaam Bashir Hassan
  • Jorgen Kristensen
  • Khalid Al Qawasmeh
  • Arif Alam
Original Article


We studied the outcome of 47 adult patients with relapsed acute leukaemia (AML = 25 and ALL = 22) treated with FLAG–mitoxantrone regimen. Median time to relapse was 10.7 months (range 1.9–27.7). Complete remission (CR2) was 60.1% which was significantly more frequent in ALL compared to AML (P = 0.049). WBC count < 100 × 109/L at initial diagnosis and time to relapse > 1 year were significantly predictor for CR2 in AML (P = 0.005 for both). Induction death was significantly higher in ALL compared to AML (P = 0.039). Median follow-up was 4.0 months (0.9–119.8) for AML and 2.1 months (range 0.6–118.1) for ALL. Nine patients underwent allogeneic stem-cell transplantation (allo-SCT). Estimated overall survival (OS) at 12 and 18 months was 60.5 and 34.6%, respectively, for AML, and 39.9 and 29.9%, respectively, for ALL. For AML patients failure to achieve CR, WBC count at initial diagnosis > 5 × 109/L and poor cytogenetic risk group was significant predictors of poor OS (P = 0.010, P = 0.025, and P = 0.015, respectively). For ALL patients failure to achieve of CR, WBC count at relapse < 5 × 109/L (CR patients) and lack of any type of consolidation therapy were significant predictor of poor OS (P < 0.001, P = 0.008, P = 0.008, respectively).


AML ALL Relapse Re-induction FLAG–mitoxantrone 



This work was supported by grants from Research Affairs, United Arab Emirates University. The authors would like to thank the staff at The National Cancer Registry, and the Medical Record Department, at Tawam Hospital, Al Ain, UAE. The authors would like to thank Mrs. Mary Kutty Jacob and to the medical students, FMHS, UAEU, who participated in the data collection.

Compliance with ethical standards

Conflict of interest

No relevant conflicts of interest to declare.


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Copyright information

© The Japanese Society of Hematology 2018

Authors and Affiliations

  • Inaam Bashir Hassan
    • 1
    • 2
  • Jorgen Kristensen
    • 3
  • Khalid Al Qawasmeh
    • 2
  • Arif Alam
    • 2
  1. 1.Department of Internal Medicine, Faculty of Medicine and Health SciencesUnited Arab Emirates UniversityAl AinUnited Arab Emirates
  2. 2.Department of HematologyOncology Tawam HospitalAl AinUnited Arab Emirates
  3. 3.Mediclinic North WingDubaiUnited Arab Emirates

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