l-asparaginase + liposomal doxorubicin + etoposide + methylprednisolone

L-DEP is a salvage chemotherapy regimen specifically designed for refractory Epstein-Barr virus-induced hemophagocytic lymphohistiocytosis (EBV-HLH). Developed by researchers at Beijing Friendship Hospital, it builds upon the DEP regimen (liposomal doxorubicin, etoposide, and methylprednisolone) by incorporating L-asparaginase. The rationale for adding L-asparaginase is its specific activity against EBV-infected T cells and NK cells, which are often the source of the cytokine storm in EBV-HLH. The regimen works through multiple mechanisms: L-asparaginase depletes asparagine, an essential amino acid for protein synthesis in malignant or infected lymphocytes; liposomal doxorubicin and etoposide induce DNA damage and inhibit topoisomerase II; and methylprednisolone provides potent anti-inflammatory and immunosuppressive effects.

Other names

L-DEP regimen