methotrexate + vincristine + pegylated l-asparaginase + dexamethasone

Combination chemotherapy regimen used primarily for relapsed or refractory acute lymphoblastic leukemia and lymphoblastic lymphoma in adults. It combines four agents with complementary mechanisms: - Methotrexate, a folate antagonist that inhibits dihydrofolate reductase and thymidylate/purine synthesis, leading to impaired DNA replication. - Vincristine, a vinca alkaloid that binds beta-tubulin and inhibits microtubule polymerization, causing mitotic arrest. - Pegylated L-asparaginase (pegaspargase), an enzyme that depletes circulating asparagine, selectively starving leukemic lymphoblasts that cannot synthesize sufficient asparagine. - Dexamethasone, a synthetic glucocorticoid that induces apoptosis and anti-proliferative effects in lymphoid malignancies and provides antiemetic/anti-inflammatory benefits. The regimen leverages schedule-dependent synergy between methotrexate and asparaginase (administering asparaginase after methotrexate to enhance efficacy and mitigate methotrexate toxicity). Often referenced as MOpAD; historical non-pegylated variant is called MOAD. Primary indication: relapsed/refractory acute lymphoblastic leukemia; sometimes used for lymphoblastic lymphoma.

Other names

MOAD regimen