cladribine + cytarabine + mitoxantrone

The combination of **cladribine**, **cytarabine**, and **mitoxantrone** is an intensive chemotherapy regimen, frequently referred to by acronyms such as **CLAM** or **CLAG-M** (when administered with granulocyte colony-stimulating factor). This regimen is primarily utilized for the induction and salvage treatment of acute myeloid leukemia (AML) and other high-grade myeloid neoplasms. The efficacy of the combination relies on a synergistic interaction where cladribine, a purine nucleoside analog, enhances the intracellular accumulation of the active metabolite of cytarabine (Ara-CTP), thereby increasing inhibition of DNA synthesis. Cytarabine acts as a pyrimidine analog that inhibits DNA polymerase, while mitoxantrone, an anthracenedione, functions as a DNA intercalator and a type II topoisomerase inhibitor, leading to double-strand breaks. This triplet is often used to achieve deep remissions (including measurable residual disease negativity) in patients with relapsed or refractory disease, frequently serving as a bridge to allogeneic hematopoietic stem cell transplantation.

Other names

CLAM regimenCLAG-M regimenGCLAM regimencladribine/cytarabine/mitoxantrone