dexamethasone + methotrexate + asparaginase + procarbazine + prednisone

This is a multi-agent chemotherapy combination consisting of the glucocorticoids dexamethasone and prednisone, the antifolate antimetabolite methotrexate, the enzyme asparaginase (typically L‑asparaginase or PEG‑asparaginase), and the alkylating agent procarbazine. It represents an intensification/salvage-type regimen conceptually similar to other asparaginase–methotrexate–steroid–based programs used in acute lymphoblastic leukemia and certain lymphomas, leveraging schedule‑dependent synergy between methotrexate and asparaginase, broad antimetabolite and DNA‑damaging cytotoxicity, and potent lympholytic and antiemetic effects from the corticosteroids.[1][5][7][8]