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ACE is a combination chemotherapy regimen consisting of doxorubicin (Adriamycin), cyclophosphamide, and etoposide. It is primarily utilized as an induction therapy for aggressive B-cell malignancies, most notably diffuse large B-cell lymphoma (DLBCL). The regimen's components work through distinct but complementary mechanisms: cyclophosphamide acts as a DNA alkylating agent that forms cross-links; doxorubicin intercalates into DNA and inhibits topoisomerase II; and etoposide further inhibits topoisomerase II, collectively leading to DNA damage and programmed cell death in malignant cells. In clinical research conducted by the Lymphoma Study Association (LYSA), the ACE regimen has been evaluated in high-risk patients as part of a dose-intense strategy, often followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT). In the LNH03-2B trial, ACE was compared against the ACVBP regimen as induction therapy prior to a second randomization evaluating rituximab consolidation.
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