Systemic Anti-Cancer Therapy Regimen Library
LEU AML Relapsed - FLAG-amsacrine [fludarabine, cytarabine, filgrastim and amsacrine] [60 years and over]
Treatment Overview
Frequency: Every 28 days or on count recovery.
This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.
Cycle 1 - 28 days
Cycle details
Cycle 1 - 28 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection | 1 to 7 | |
| amsacrine | 100 mg/m² Once daily | intravenous | 2, 3, 4 | 60 minutes |
| fludarabine * | 30 mg/m² Once daily | intravenous | 2 to 6 | 30 minutes |
| cytarabine | 1000 mg/m² Once daily | intravenous | 2 to 6 | 4 hours |
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye | 2 to 8 |
Full details
Cycle 1 - 28 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection | ||
| amsacrine | 100 mg/m² Once daily | intravenous | 60 minutes |
Instructions:
Must be diluted in glucose 5%. Incompatible with sodium chloride 0.9%. Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| fludarabine * | 30 mg/m² Once daily | intravenous | 30 minutes | |
| cytarabine | 1000 mg/m² Once daily | intravenous | 4 hours |
Instructions:
Commence 4 hours after the fludarabine infusion. |
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye |
Instructions:
Instil ONE drop into each eye every FOUR hours on days 2 to 8. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection | ||
| amsacrine | 100 mg/m² Once daily | intravenous | 60 minutes |
Instructions:
Must be diluted in glucose 5%. Incompatible with sodium chloride 0.9%. Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| fludarabine * | 30 mg/m² Once daily | intravenous | 30 minutes | |
| cytarabine | 1000 mg/m² Once daily | intravenous | 4 hours |
Instructions:
Commence 4 hours after the fludarabine infusion. |
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye |
Instructions:
Instil ONE drop into each eye every FOUR hours on days 2 to 8. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection | ||
| amsacrine | 100 mg/m² Once daily | intravenous | 60 minutes |
Instructions:
Must be diluted in glucose 5%. Incompatible with sodium chloride 0.9%. Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| fludarabine * | 30 mg/m² Once daily | intravenous | 30 minutes | |
| cytarabine | 1000 mg/m² Once daily | intravenous | 4 hours |
Instructions:
Commence 4 hours after the fludarabine infusion. |
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye |
Instructions:
Instil ONE drop into each eye every FOUR hours on days 2 to 8. |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection | ||
| fludarabine * | 30 mg/m² Once daily | intravenous | 30 minutes | |
| cytarabine | 1000 mg/m² Once daily | intravenous | 4 hours |
Instructions:
Commence 4 hours after the fludarabine infusion. |
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye |
Instructions:
Instil ONE drop into each eye every FOUR hours on days 2 to 8. |
Day: 6
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection | ||
| fludarabine * | 30 mg/m² Once daily | intravenous | 30 minutes | |
| cytarabine | 1000 mg/m² Once daily | intravenous | 4 hours |
Instructions:
Commence 4 hours after the fludarabine infusion. |
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye |
Instructions:
Instil ONE drop into each eye every FOUR hours on days 2 to 8. |
Day: 7
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim * | 300 microgram Once daily | subcutaneous injection | ||
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye |
Instructions:
Instil ONE drop into each eye every FOUR hours on days 2 to 8. |
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prednisolone acetate 1% (10 mg/mL) eye drops * | 1 Drop Every four hours | application to the eye |
Instructions:
Instil ONE drop into each eye every FOUR hours on days 2 to 8. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Antifungal prophylaxis: | Routine antifungal prophylaxis recommended |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis recommended |
| Emetogenicity: | Medium |
| Irradiated blood components: | Irradiation of blood components is recommended |
| Ocular toxicity risk: | High - administer corticosteroid eyedrops to minimise corneal toxicity |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Tumour lysis syndrome prophylaxis: | Variable |
Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.
PJP prophylaxis with co-trimoxazole: Consider starting after count recovery.
Tumour lysis syndrome prophylaxis: Recommended for first cycle of treatment and only for further cycles if not in complete remission.
References
Eurocept International BV Amsidine Summary of product characteristics 30 March 2022 https://www.medicines.org.uk/emc/product/13279/smpc#gref (accessed 11 July 2022).
New Zealand Blood Service Transfusion Medicine Handbook Third Edition, 2016 https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111G122.pdf (accessed 13/7/2022).
Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.