dexamethasone + vindesine + methotrexate + ifosfamide + daunorubicin + pegylated-asparaginase

This is a multi-agent chemotherapy regimen composed of six drugs—dexamethasone, vindesine, methotrexate, ifosfamide, daunorubicin, and pegylated-asparaginase (pegaspargase). Each component has a distinct mechanism of action targeting different aspects of cancer cell biology: - **Dexamethasone** is a synthetic glucocorticoid with anti-inflammatory and immunosuppressive properties. In leukemia therapy, it induces apoptosis in lymphoid cells. - **Vindesine** is a vinca alkaloid that inhibits microtubule formation during mitosis. - **Methotrexate** is an antimetabolite that inhibits dihydrofolate reductase, blocking DNA synthesis. - **Ifosfamide** is an alkylating agent causing cross-linking of DNA strands. - **Daunorubicin** (an anthracycline) intercalates into DNA and inhibits topoisomerase II activity leading to DNA breaks. - **Pegylated-asparaginase (pegaspargase)** depletes asparagine by enzymatic hydrolysis; leukemic lymphoblasts are unable