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Background The prognosis for relapsed or refractory acute myeloid leukemia (RR-AML) in children is poor,and the preferred salvage chemotherapy is unclear.One regimen is cladribine,cytarabine,and granulocyte-colony stimulating factor (CLAG),but little is known about its efficacy and safety in children with RR-AML.Methods We enrolled RR-AML patients aged 0-18 years who received modified CLAG regimen for re-induction between July 1,2015 and April 1,2018,or conventional induction between August 1,2011 and April 1,2018.Patients were followed up to March 31,2019.Patients underwent allogeneic stem cell transplantation (allo-SCT) or chemotherapy after the induction of complete remission (CR).The CR rate,survival,and side effects were analyzed.Results The CR rate for induction was 66.7％ after one cycle and 75.0％ after two cycles of the CLAG regimen in 12 children.The nine children who received conventional chemotherapy had a CR rate of 22.2％ after one cycle and 33.3％ after two cycles (P =0.087 vs.CLAG).The 3-year event-free survival (EFS) of the CLAG group and the conventional treatment group were 44.4 ± 15.7％ and 22.2± 13.8％ (P=0.112).The 3-year overall survival of the two groups were 59.5 ± 16.2％ and 22.2％ ± 13.8％ (P=0.057).The 3-year EFS for allo-SCT and chemotherapy after CLAG regimen was 66.7 ± 19.2％ and 25.0 ± 21.7％ (P =0.015).A single case of chemotherapy-related death was recorded.Conclusion Our data suggest a promising CR rate using CLAG salvage treatment in childhood RR-AML.Allo-SCT after CR may improve the long-term outcome in these patients.