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DECA is a combination chemotherapy regimen consisting of dexamethasone, etoposide, cytarabine (Ara-C), and cisplatin. Developed and studied by the Baylor College of Medicine, it is primarily utilized as an augmentation therapy for pediatric and young adult patients with newly diagnosed low and intermediate-risk Hodgkin lymphoma who demonstrate a slow early response (SER) to initial treatment. The regimen functions through multiple mechanisms: dexamethasone acts as a glucocorticoid receptor agonist to induce apoptosis in lymphoid cells; etoposide inhibits topoisomerase II, leading to DNA strand breaks; cytarabine acts as a pyrimidine analog that inhibits DNA polymerase; and cisplatin forms inter- and intra-strand DNA cross-links. This risk-adapted approach aims to improve outcomes in patients at higher risk of relapse while potentially sparing rapid responders from additional toxicity.
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