methotrexate + hydrocortisone + cytarabine + leucovorin

This drug is a fixed-dose combination of four agents: methotrexate, hydrocortisone, cytarabine, and leucovorin. It is primarily administered via the intrathecal route as central nervous system (CNS) prophylaxis or treatment in hematological malignancies such as acute lymphoblastic leukemia and acute myeloid leukemia[1][2][3]. - **Methotrexate** acts as an antimetabolite by inhibiting dihydrofolate reductase and other enzymes involved in nucleotide synthesis, thereby preventing cell division[6]. - **Cytarabine** is a nucleoside analog that inhibits DNA synthesis. - **Hydrocortisone** provides anti-inflammatory effects and may help reduce neurotoxicity associated with chemotherapy. - **Leucovorin** serves as a "rescue" agent to mitigate the toxic effects of methotrexate on normal cells by providing reduced folates for DNA synthesis[5]. The combination aims to maximize CNS penetration while reducing systemic toxicity. This regimen has been shown to induce CNS remission in pediatric leukemias; however, neurotoxicity can occur with combined use or cumulative dosing of these agents[2][3].

Other names

intrathecal triple therapy (when used without leucovorin, but sometimes the term is used for this combination)triple intrathecal chemotherapy (when used without leucovorin, but sometimes the term is used for this combination)