L-asparaginase + methotrexate + idarubicin + etoposide + cyclophosphamide + cytarabine + mercaptopurine

This is a **combination chemotherapy regimen** comprising seven cytotoxic agents: **L-asparaginase**, **methotrexate**, **idarubicin**, **etoposide**, **cyclophosphamide**, **cytarabine**, and **mercaptopurine**. Each component has a distinct mechanism of action, collectively aiming for maximal antitumor activity via multiple biological pathways commonly used for the treatment of various leukemias. L-asparaginase depletes asparagine, inhibiting protein synthesis in leukemic cells; methotrexate is a folate analog that inhibits dihydrofolate reductase, blocking DNA synthesis; idarubicin is an anthracycline antibiotic intercalating DNA and inhibiting topoisomerase II; etoposide inhibits topoisomerase II, causing DNA damage; cyclophosphamide is an alkylating agent that cross-links DNA; cytarabine is a nucleoside analog inhibiting DNA synthesis; mercaptopurine is a purine analog that disrupts nucleotide synthesis. This comprehensive regimen is typically used in aggressive leukemias, including acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), especially in relapsed or refractory cases[1][7]. The rationale for combining these agents is to target leukemic cells through various mechanisms and cell cycle phases, reducing the risk of resistance and improving outcomes.