bortezomib + bendamustine + melphalan

This is a combination regimen consisting of three chemotherapeutic agents—bortezomib, bendamustine, and melphalan—used primarily in the treatment of multiple myeloma. - **Bortezomib** is a small molecule proteasome inhibitor that disrupts the 26S proteasome, leading to cell cycle arrest and apoptosis in cancer cells. It is approved for use in multiple myeloma and mantle cell lymphoma[4][5][10]. - **Bendamustine** is a bifunctional alkylating agent with both alkylator and antimetabolite activities. It induces DNA cross-linking resulting in cell death, inhibits mitotic checkpoints, deregulates DNA repair genes, activates proapoptotic genes, and can overcome resistance to other alkylators like melphalan[2][3][6]. - **Melphalan** is an alkylating agent that causes DNA cross-linking and subsequent inhibition of DNA replication and transcription. The combination leverages complementary mechanisms to enhance anti-myeloma activity. This regimen has been explored as induction therapy prior to autologous stem cell transplantation or for relapsed/refractory disease settings[8]. The combination aims to maximize cytotoxicity while minimizing overlapping toxicities.