etoposide + prednisone + vincristine + cyclophosphamide + doxorubicin + fludarabine + rituximab

This is a multi-agent chemotherapy and immunotherapy regimen combining seven drugs: etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, fludarabine, and rituximab. It is an extension of the DA-EPOCH-R regimen (dose-adjusted etoposide, prednisone, vincristine [Oncovin], cyclophosphamide, doxorubicin [hydroxydaunorubicin], and rituximab), with the addition of fludarabine. The combination is designed for aggressive lymphoid malignancies—particularly as a preparative regimen before reduced-intensity conditioning allogeneic hematopoietic stem-cell transplantation (RIC-alloHSCT). Each component has a distinct mechanism: - Etoposide inhibits topoisomerase II. - Prednisone is a glucocorticoid that induces apoptosis in lymphoid cells. - Vincristine disrupts microtubule formation. - Cyclophosphamide alkylates DNA. - Doxorubicin intercalates DNA and inhibits topoisomerase II. - Fludarabine inhibits DNA synthesis by acting as a purine analog. - Rituximab targets CD20 on B-cells to induce cell death via immune-mediated mechanisms. The addition of fludarabine enhances lymphocyte depletion to facilitate engraftment in transplantation settings. This combination provides both cytoreduction of tumor burden and profound immunosuppression[1].

Other names

DA-EPOCH-F/Rdose-adjusted EPOCH-fludarabine-rituximab