carmustine + doxorubicin + melphalan

**Carmustine + doxorubicin + melphalan** is a combination chemotherapy regimen consisting of three cytotoxic agents used primarily in the treatment of multiple myeloma. Carmustine (BCNU) is a nitrosourea alkylating agent that cross-links DNA strands inhibiting replication and transcription, doxorubicin is an anthracycline antibiotic that intercalates DNA and inhibits topoisomerase II leading to DNA damage, and melphalan is a nitrogen mustard alkylating agent that forms DNA cross-links via guanine alkylation. Administered intravenously (doxorubicin followed by carmustine) with oral melphalan, this regimen leverages synergistic cytotoxic effects for induction therapy or disease control in aggressive or symptomatic multiple myeloma, though it carries risks of bone marrow suppression, pulmonary toxicity, and cardiotoxicity.[1][7]