CLAG-M

Say it: CLAG M

Cladribine, cytarabine, filgrastim and mitoxantrone

CLAG-M is a strong mix of four medicines given in the hospital to try to bring acute myeloid leukemia (AML) into remission.

Also called: CLAG, CLAGM, CLAG M, CLAG-Mito, cladribine cytarabine G-CSF mitoxantrone

What it is

Cladribine helps cytarabine build up inside leukemia cells so it works better. Filgrastim (G-CSF) wakes up leukemia cells so chemotherapy can kill them more easily. Mitoxantrone adds another way to kill the cells. The goal is remission, often followed by a stem cell transplant.

Often used for

• acute myeloid leukemia (AML) that came back or did not respond to treatment
• high risk AML as first treatment, at some centers

CLAG

The same plan without mitoxantrone. It may be used for people who cannot get more anthracycline type medicines because of heart concerns.

Second cycle

If leukemia is reduced but not gone, a second cycle may be given. Some people then get a lower dose cycle before a stem cell transplant.

The medicines in this plan

Cladribine

Chemotherapy given through a vein over about 2 hours each day for 5 days.

Cytarabine

Chemotherapy given through a vein over a few hours each day for 5 days, a few hours after cladribine.

Filgrastim

A growth factor shot under the skin, started a day before or the same day as chemotherapy, to prime the leukemia cells.

Mitoxantrone

Chemotherapy given through a vein on about 3 days. It can turn urine blue green for a day or two.

How you get it

CLAG-M is given in the hospital through a central line. Chemotherapy lasts about 5 days, and you usually stay in the hospital for about 3 to 5 weeks until blood counts recover. Most people get 1 or 2 cycles. Your schedule may be different.

A typical cycle

Day 0

Filgrastim shot is started in the hospital.

Days 1 to 5

Cladribine, then cytarabine, through the IV each day. Filgrastim continues.

Days 1 to 3

Mitoxantrone through the IV.

Days 6 to 28

Blood counts drop very low. Transfusions and antibiotics are common. A bone marrow test around day 14 to 28 checks the response.

Count recovery

When counts come back up, you can usually go home. Your team plans the next step.

Common side effects and what helps

• Very low blood counts for weeks, with a high risk of infection. You will get antibiotics, antifungal and antiviral medicines to prevent infection.
• Need for blood and platelet transfusions. These are common and expected.
• Fever, which can be from infection or from the medicines. Your team checks every fever.
• Nausea and poor appetite. Anti-nausea medicines are given on a schedule.
• Mouth sores. Use soft toothbrushes and gentle mouth rinses.
• Bone aches from filgrastim. Ask about what pain medicine is safe.
• Hair loss and tiredness. Rest when you need to.
• Blue green urine for a day or two after mitoxantrone. This is harmless.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Bleeding that will not stop, blood in your urine or stool, or many new bruises
• Trouble breathing, chest pain, or a fast or pounding heartbeat
• Dizziness or fainting
• Throwing up or diarrhea that keeps you from drinking or keeping down your medicines
• Redness, pain or drainage where your IV line enters the skin

Good to know

• You will have a heart test (echocardiogram) before treatment because mitoxantrone can affect the heart.
• Your team watches for tumor lysis (fast breakdown of leukemia cells) with blood tests and gives fluids and medicines to protect your kidneys.
• Blood products may need to be irradiated (treated with radiation) to prevent a rare transfusion problem.
• A bone marrow test after the cycle shows whether the leukemia is in remission.
• Many people go on to a stem cell transplant after remission.

At home

• After you go home, check your temperature twice a day and any time you feel unwell.
• Wash your hands often and stay away from people who are sick.
• Keep all blood test and transfusion visits.
• Avoid raw or undercooked foods while your counts are low, if your team advises it.
• Keep your central line dry and covered.

Questions to ask

• How long will I be in the hospital?
• Will I need a second cycle?
• Am I a candidate for a stem cell transplant?
• What medicines will I take to prevent infection?
• How will we know if the treatment worked?

Leukemia

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.