cytarabine + mitoxantrone + pegaspargase

This is a multi-agent chemotherapy regimen combining high‑dose cytarabine, mitoxantrone, and pegaspargase, sometimes termed HAM‑pegA, used experimentally for acute leukemias such as Philadelphia chromosome–positive mixed phenotype acute leukemia (Ph+ MPAL). Cytarabine is a pyrimidine nucleoside antimetabolite that is phosphorylated intracellularly and incorporated into DNA, inhibiting DNA polymerase and DNA synthesis, particularly in rapidly dividing leukemic blasts.[4] Mitoxantrone is an anthracenedione topoisomerase II inhibitor that intercalates into DNA and induces double‑strand breaks, leading to apoptosis of proliferating cells. Pegaspargase is a pegylated L‑asparaginase enzyme that depletes circulating L‑asparagine, exploiting leukemic lymphoblasts’ dependence on exogenous asparagine and causing selective leukemic cell death.[5][3][7] The combination is designed to blend myeloid‑directed cytarabine/mitoxantrone with lymphoid‑directed pegaspargase to achieve intensive cytoreduction in mixed‑phenotype or high‑risk acute leukemias.[1][8]

Other names

HAM-pegAHAMpegAhigh dose cytarabine + mitoxantrone + pegaspargase