dexamethasone + cytarabine + etoposide + pegylated-asparaginase

This is a combination chemotherapy regimen consisting of four agents: - **Dexamethasone** (a synthetic glucocorticoid corticosteroid with anti-inflammatory and immunosuppressant properties) - **Cytarabine** (an antimetabolite that inhibits DNA synthesis, primarily used in hematologic malignancies) - **Etoposide** (a topoisomerase II inhibitor that induces DNA strand breaks, leading to apoptosis in rapidly dividing cells) - **Pegylated-asparaginase** (an enzyme conjugated with polyethylene glycol to increase half-life and reduce immunogenicity; it depletes asparagine, an amino acid essential for the survival of certain leukemic cells) This combination is designed for the treatment of hematological malignancies such as acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma. Each component targets cancer cells through different mechanisms—dexamethasone suppresses inflammation and immune response; cytarabine disrupts DNA synthesis; etoposide causes double-strand DNA breaks; pegylated-asparaginase deprives tumor cells of asparagine. The use of pegylated-asparaginase allows for less frequent dosing compared to native L-asparaginase due to its prolonged half-life[7][8][9]. This regimen or similar combinations have been studied in relapsed/refractory ALL and lymphoma settings.