FLAG-Ida is used to treat acute myeloid leukaemia (AML). It is sometimes used to treat acute lymphoblastic leukaemia (ALL).
This information should ideally be read with our general information about chemotherapy and the type of cancer you have.
The drugs used in FLAG-IdaBack to top
The term FLAG-Ida comes from the letters in the names of the drugs used:
FLAG-Ida chemotherapy treatment will be given to you in hospital. You will be in hospital for a few weeks after the chemotherapy while your blood levels are low. When your blood cells are getting back to their normal levels, you will be able to go home.
A chemotherapy nurse will give you your treatment. You will also see a cancer doctor, a blood specialist (haematologist) or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (a phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. They give you the drugs and the chemotherapy through one of the following:
- a fine tube that goes under the skin of your chest and into a vein close by (central line or Hickman line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you:
- fludarabine as a drip over 30 minutes
- cytarabine (Ara-C) as a drip over four hours (four hours after fludarabine)
- idarubicin, either directly into your line as an injection, or as a drip over 10–15 minutes.
The nurse will usually run the drip through a pump, which gives you the chemotherapy over a set time. They give you G-CSF as an injection under the skin (subcutaneously) once a day.
Your course of FLAG-Ida
Flag-IDA is usually given over seven days. You will have your treatment in hospital and will need to stay there while your blood counts are low. But some people may be able to go home for a few days straight after the treatment has been given, until the number of blood cells starts to go down.
On days 1–7 you will have an injection of GCSF under the skin. G-CSF helps the leukaemia cells to divide. This means the chemotherapy can destroy these cells more easily. You may have this injection after chemotherapy, to help the normal blood cells recover.
On days 2–6 your nurse will give you fludarabine and cytarabine. They are both given as a drip (infusion). The cytarabine will be given four hours after fludarabine.
On days 4–6 they will give you idarubicin. You may have this as a slow injection through your line with a drip to flush it through. Or you can have it as a drip.
This completes one cycle of your chemotherapy treatment. You will have a rest period in hospital with no treatment while your blood cells recover. This can take 3–4 weeks or sometimes longer, but it will be different for everyone.
At the end of this rest period, you may start a second cycle of FLAG-Ida. Some people only have one cycle of FLAG-Ida. Your nurse or doctor will tell you how many cycles you are likely to have.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy.
Idarubicin may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include:
- a rash
- feeling itchy
- feeling flushed or short of breath
- swelling of your face or lips
- feeling dizzy
- having pain in your tummy, back or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
Pain along the vein
Tell your nurse straight away if you have pain along the vein. They will check your drip site and slow the drip to ease the pain.
The drug leaks outside the vein
If idarubicin leaks outside the vein when you’re having treatment, it can damage the tissue around it. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein.
Extravasation is not common, but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Possible side effects of FLAG-IdaBack to top
We explain the most common side effects of FLAG-Ida here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. As you will be in hospital, your doctors and nurses will check you regularly. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. After your treatment is over, the side effects will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you a telephone number or numbers to call the hospital if you feel unwell or need advice at any time of the day or night. Save these numbers in your mobile phone or keep them somewhere safe.
More information about FLAG-Ida
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
FLAG-Ida can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia. Your nurse will give you G-CSF under the skin as part of your treatment. G-CSF encourages the bone marrow (where blood cells are made) to make more white blood cells.
While you’re in hospital, the nurses will check you regularly for signs of infection. You will also have daily blood tests to check your number of blood cells (blood count).
When you are home, contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Bruising and bleeding
FLAG-Ida can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. Bruising and bleeding includes:
- bleeding gums
- blood spots
- rashes on the skin.
Some people may need a drip to give them extra platelets.
FLAG-Ida can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
Feeling sick and being sick
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness.
Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick, tell your nurse or doctor. They can change the anti-sickness drugs so they work better for you.
Feeling very tired is a common side effect. You’ll probably feel tired for some months after your treatment finishes. Try to pace yourself and get as much rest as you need. It helps to balance this with doing some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures every morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have problems with your mouth. They can prescribe mouthwashes and medicines to prevent or clear any mouth infections.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better.
Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Tummy pain and bleeding from the bowel
Idarubicin can irritate the lining of the stomach. This may cause a stomach ulcer. Tell your doctor if you have pain in your tummy or if you have indigestion. Your doctor may prescribe drugs to help reduce stomach irritation.
Idarubicin may also cause bleeding from the bowel. Tell your doctor straight away if you notice blood when your bowels move or your stool is darker.
Cytarabine may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe steroid eye drops to prevent this. It’s important to use these as instructed.
Cytarabine may also make your eyes more sensitive to light and cause blurry vision and/or pain in the eyes. Always tell your doctor or nurse if you have any pain or notice any change in your vision.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. Hair loss is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Idarubicin can cause a rash, which may be itchy. Your skin may darken. It will return to its normal colour after you finish treatment.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30 and cover up with clothing and a hat. If you’ve had radiotherapy (either recently or in the past), the area that was treated may become red or sore.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Numb or tingling hands or feet
These symptoms are caused by the effect of fludarabine on the nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Always tell your doctor if you have these symptoms. The symptoms usually improve slowly after treatment finishes.
Your nails may become darker and you may see white lines on them. These usually grow out over several months after treatment ends.
Your urine may become a pink-red colour for up to two days after your treatment. This is due to the colour of idarubicin.
Changes in the way the kidneys and liver work
FLAG-Ida can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before chemotherapy to check how well your kidneys and liver are working.
Tell your doctor or nurse if you have headaches. They can give you painkillers to help.
G-CSF may cause discomfort or a dull ache in the bones of your pelvis, back, arms or legs. Your doctor can prescribe pain relief if needed.
Sore and red hands and feet
Having sore and red palms of hands and soles of feet is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Effects on the nervous system
Fludarabine and cytrabine can affect the nervous system. You may:
- feel anxious or restless
- have problems sleeping
- experience mood changes
- feel drowsy or confused.
Rarely, fludarabine and cytarabine can cause seizures (fits).
Tell your doctor or nurse straight away if you notice any of these symptoms.
Less common side effects of FLAG-IdaBack to top
Effects on the lungs
Cytarabine can cause changes to the lungs. These are more common if you are treated with higher doses of FLAG-Ida.
Always tell your doctor if you:
- are wheezing
- develop a cough
- have a fever
- feel breathless.
You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Changes in the way the heart works
Idarubicin and fludarabine can affect the way the heart works, but this is usually temporary. You may have tests to see how well your heart is working before chemotherapy. Some people have tests before each treatment.
Tell a doctor straight away if you notice these symptoms at any time during or after treatment:
- changes to your heartbeat
- pain or tightness in your chest.
These symptoms can be caused by other conditions, but it’s very important to get them checked out.
Raised levels of uric acid in the blood
FLAG-Ida may cause the leukaemia cells to break down quickly. This releases uric acid (a waste product) into the blood. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you tablets called allopurinol (Zyloric ®) to help prevent this. Drinking at least two litres (three and a half pints) of fluids a day will also help. You will have regular blood tests to check the uric acid levels.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about FLAG-IdaBack to top
After treatment with fludarabine, any blood and platelets you are given should first be treated with radiation. This lowers the risk of the donated blood cells reacting against your own. It won’t damage the blood or make you radioactive.
Your doctor will record in your medical notes that you should only be given irradiated blood products. They’ll also give you a card to carry in case you’re treated at another hospital. Keep this card with you at all times and remind your hospital team that any blood or platelets you need must be irradiated.
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as:
- pain, redness and swelling in a leg
- chest pain.
Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some other medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
FLAG-Ida may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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