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MAD + CP is a combination chemotherapy regimen utilized as a reduced-toxicity backbone for the treatment of pediatric and young adult patients with mature B-cell non-Hodgkin lymphoma (MB-NHL). The regimen is structured into two distinct modules: **MAD**, which consists of high-dose **methotrexate**, **cytarabine** (Ara-C), and **dexamethasone**; and **CP**, which includes **cyclophosphamide** and **prednisone**. This specific combination is a key component of the **RADICAL** clinical trial (NCT05439239), led by **New York Medical College**, where it is evaluated in conjunction with targeted immunotherapies such as **polatuzumab vedotin** or **nivolumab**. The primary objective of the MAD + CP backbone is to maintain high rates of disease control while significantly reducing cumulative exposure to anthracyclines and radiation, thereby mitigating long-term toxicities such as cardiotoxicity and secondary malignancies in children, adolescents, and young adults.
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