bortezomib + mitoxantrone + etoposide + cytarabine

This is a combination chemotherapy regimen consisting of four drugs—bortezomib, mitoxantrone, etoposide, and cytarabine—used primarily in the treatment of relapsed or refractory acute myeloid leukemia (AML). Bortezomib is a small molecule proteasome inhibitor that disrupts protein degradation pathways in cancer cells, leading to apoptosis. Mitoxantrone is an anthracenedione antineoplastic agent that intercalates into DNA and inhibits topoisomerase II. Etoposide is a topoisomerase II inhibitor causing DNA strand breaks. Cytarabine is an antimetabolite that inhibits DNA synthesis by acting as a cytidine analog. The rationale for combining these agents lies in their complementary mechanisms of action targeting different aspects of leukemic cell survival and proliferation. Clinical studies have shown this combination can achieve encouraging remission rates in patients with relapsed or refractory AML[1][3][4][7].