rituximab + cyclophosphamide + doxorubicin + vindesine + prednisone + lenalidomide

This is a multi-agent combination chemotherapy and immunotherapy regimen composed of six drugs: - **Rituximab** (a monoclonal antibody targeting CD20 on B cells, leading to cell lysis via immune-mediated mechanisms) - **Cyclophosphamide** (an alkylating agent that crosslinks DNA, inhibiting cell division) - **Doxorubicin** (an anthracycline antibiotic that intercalates DNA and inhibits topoisomerase II, causing DNA damage) - **Vindesine** (a vinca alkaloid that inhibits microtubule assembly, disrupting mitosis; note this is sometimes substituted for vincristine in similar regimens) - **Prednisone** (a synthetic glucocorticoid with lympholytic and anti-inflammatory effects) - **Lenalidomide** (an immunomodulatory drug with antiangiogenic properties and direct antineoplastic activity) This combination builds upon the established R-CHOP backbone used for diffuse large B-cell lymphoma by adding lenalidomide for its additional efficacy in aggressive lymphomas. The regimen has been studied primarily in elderly or high-risk patients with untreated diffuse large B-cell lymphoma. Early-phase studies suggest it is safe and effective, achieving high response rates[1][7]. Vindesine serves a similar role to vincristine as a microtubule inhibitor.