fludarabine + cytarabine + mitoxantrone

A combination chemotherapy regimen of **fludarabine**, **cytarabine (also known as Ara-C)**, and **mitoxantrone** is used as *salvage therapy* primarily for patients with relapsed or refractory acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and blastic phase chronic myeloid leukemia (CML-BP)[2][3][4]. - **Fludarabine** is a purine analog that inhibits DNA synthesis and repair by incorporating into DNA and RNA, resulting in chain termination and apoptosis. - **Cytarabine** is a pyrimidine analog, acting as an antimetabolite that inhibits DNA polymerase, leading to DNA synthesis arrest and apoptosis. - **Mitoxantrone** is an anthracenedione antineoplastic agent that intercalates into DNA and inhibits topoisomerase II, causing DNA strand breaks and preventing cell replication. The rationale for this combination, often called FLAM (fludarabine, cytarabine, mitoxantrone) or FLAGM (fludarabine, high-dose cytarabine, mitoxantrone), is that fludarabine increases the intracellular concentration of cytarabine’s active metabolite, potentiating its cytotoxic effect; mitoxantrone further augments DNA damage by interfering with DNA repair and synthesis[2][4][10]. Typical use is in patients with poor prognosis after relapse or failed prior remission, either as a bridge to stem cell transplantation or as an intensive salvage regimen[2][3][4].

Other names

FLAMFLAGMMito-FLAG