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This is an intensive multi-agent chemotherapy regimen that combines the antimetabolite cytarabine, the anthracycline analog aclarubicin, the hematopoietic growth factor granulocyte colony-stimulating factor (G-CSF), and the anthracenedione topoisomerase II inhibitor mitoxantrone. Low-dose cytarabine plus aclarubicin with concurrent G-CSF priming (often termed CAG) has been used as salvage or lower-intensity therapy in relapsed or refractory acute myeloid leukemia (AML) and myelodysplastic syndromes, leveraging G-CSF to recruit leukemic blasts into cycle and sensitize them to cytotoxic agents.[2][8][11] Mitoxantrone in combination with cytarabine is an established antineoplastic backbone for AML, where mitoxantrone intercalates DNA and inhibits topoisomerase II, and cytarabine is incorporated into DNA to block chain elongation, together inducing DNA damage and apoptosis in rapidly dividing myeloid blasts.[1][7][10][13][15] The four-drug combination is therefore a cytotoxic, non-targeted, small-molecule regimen aimed at intensifying antileukemic activity while G-CSF mitigates neutropenia and may enhance chemosensitivity.
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