prednisone + vincristine + pegaspargase + bortezomib + cytarabine + cyclophosphamide + daunorubicin + 6-mercaptopurine + methotrexate + dexamethasone + doxorubicin + vindesine + etoposide + ifosfamide

This is a **multi-agent chemotherapy regimen** composed of 14 drugs: prednisone, vincristine, pegaspargase, bortezomib, cytarabine, cyclophosphamide, daunorubicin, 6-mercaptopurine, methotrexate, dexamethasone, doxorubicin, vindesine, etoposide, and ifosfamide. The regimen includes small molecules from a range of classes—corticosteroids (prednisone, dexamethasone), vinca alkaloids (vincristine, vindesine), asparaginase enzyme (pegaspargase), proteasome inhibitor (bortezomib), antimetabolites (cytarabine, methotrexate, 6-mercaptopurine), alkylating agents (cyclophosphamide, ifosfamide), anthracyclines (daunorubicin, doxorubicin), and a topoisomerase II inhibitor (etoposide). The drugs act via complementary mechanisms to induce cytotoxicity in rapidly dividing malignant cells, primarily by interfering with cell division, DNA synthesis, or cellular metabolism. This type of regimen is typically investigated or used for the treatment of **acute lymphoblastic leukemia (ALL)** and related hematologic malignancies, especially in relapse or refractory settings, or high-risk protocols. Each drug in the combination has a well-established mechanism and contributes to the overall cytotoxic effect through a distinct cellular pathway[1][5][7].