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Pixantrone + cytarabine + methylprednisolone + cisplatin is a **four-drug chemotherapy combination regimen** primarily investigated as salvage therapy for **relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL)**. This regimen is modeled on the ESHAP protocol, with pixantrone (a DNA-intercalating aza-anthracenedione designed to reduce cardiotoxicity) replacing etoposide. Pixantrone acts as an antineoplastic agent by interfering with DNA replication and repair; cytarabine is an antimetabolite inhibiting DNA synthesis; cisplatin forms DNA crosslinks causing apoptosis; methylprednisolone is a synthetic corticosteroid exerting lympholytic and anti-inflammatory effects. The combination exploits complementary mechanisms to induce cell death in lymphoma cells. It has been studied in phase I/II trials for safety and efficacy, particularly for patients pretreated with anthracyclines, and is considered as a stem cell mobilization regimen as well[1][3][4][5][7].
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