homoharringtonine + venetoclax + azacitidine + G-CSF

The HVAG regimen is a combination therapy consisting of homoharringtonine (HHT), venetoclax (VEN), azacitidine (AZA), and granulocyte colony-stimulating factor (G-CSF). This regimen is being investigated by the Shanghai Jiao Tong University School of Medicine as a first-line treatment for newly diagnosed elderly patients with acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy. Homoharringtonine is a plant alkaloid that inhibits protein synthesis by binding to the ribosomal A-site, thereby preventing the elongation phase of translation. Venetoclax is a selective B-cell lymphoma 2 (BCL-2) inhibitor that promotes apoptosis in leukemia cells by displacing pro-apoptotic proteins. Azacitidine is a hypomethylating agent that incorporates into DNA and RNA, inhibiting DNA methyltransferases and leading to the reactivation of tumor suppressor genes. G-CSF is included to stimulate granulocyte production and potentially sensitize leukemic blasts to the cytotoxic effects of the other agents. The combination aims to exploit synergistic effects, particularly between HHT and venetoclax, which has been shown to reduce the expression of anti-apoptotic proteins like BCL-XL and MCL-1.

Other names

HVAG regimenHHT + VEN + AZA + G-CSFHomoharringtonine + Venetoclax + Azacitidine + Granulocyte Colony-Stimulating Factor