cladribine + cytarabine + etoposide + mitoxantrone

A combination chemotherapy regimen consisting of cladribine, cytarabine, etoposide, and mitoxantrone, specifically developed and evaluated by the Children's Oncology Group (COG) for the treatment of pediatric and young adult patients with relapsed or refractory acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). This regimen, notably studied in the Phase II trial AAML0021, utilizes the synergistic biochemical interaction between nucleoside analogs and topoisomerase II inhibitors. Cladribine is included to enhance the intracellular accumulation of cytarabine triphosphate (Ara-CTP), the active metabolite of cytarabine, thereby increasing its antileukemic activity. Mitoxantrone and etoposide provide potent DNA intercalation and topoisomerase II inhibition, leading to extensive double-strand DNA breaks and apoptosis in resistant leukemic blasts. This intensive salvage therapy is intended to induce complete remission in high-risk patients who have failed initial induction or experienced early relapse.

Other names

mitoxantrone-Children's Oncology Group-acute myeloid leukemia-myelodysplastic syndromeCLAM-Emitoxantrone hydrochloridecladribine + ara-C + etoposide + mitoxantrone