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We developed a cross-layer design which combines adaptive modulation and coding at the physical layer with a truncated automatic repeat request protocol at the data link layer, in order to maximize spectral efficiency under prescribed delay and error performance constraints. We derive the achieved spectral efficiency in closed-form for transmissions over Nakagami-m block fading channels. Numerical results reveal that retransmissions at the data link layer relieve stringent error control requirements at the physical layer, and thereby enable considerable spectral efficiency gain. This gain is comparable with that offered by diversity, provided that the maximum number of transmissions per packet equals the diversity order. Diminishing returns on spectral efficiency, that result when increasing the maximum number of retransmissions, suggest that a small number of retransmissions offers a desirable delay-throughput tradeoff, in practice.