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This intensive multi-agent chemotherapy combination consists of etoposide, thioguanine, cyclophosphamide, busulfan, and melphalan. It was evaluated by the Dutch Childhood Oncology Group (DCOG) as a conditioning or intensive re-induction regimen for pediatric and adolescent patients with relapsed or refractory acute myeloid leukemia (AML). The regimen leverages multiple cytotoxic pathways: etoposide inhibits DNA topoisomerase II; thioguanine acts as a purine antimetabolite; and cyclophosphamide, busulfan, and melphalan serve as potent DNA alkylating agents. This combination is designed to overcome multi-drug resistance in aggressive myeloid leukemias, often serving as a bridge to hematopoietic stem cell transplantation.
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