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This is a combination chemo-immunotherapy regimen composed of the anti-CD20 monoclonal antibody rituximab and the chemotherapy agents mitoxantrone, vincristine, and teniposide, along with a corticosteroid, typically prednisolone. Rituximab targets the CD20 antigen expressed on the surface of B-lymphocytes, inducing cell death through antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity. Mitoxantrone and teniposide serve as potent topoisomerase II inhibitors that interfere with DNA replication and induce double-strand breaks; mitoxantrone also functions as a DNA intercalator. Vincristine is a vinca alkaloid that binds to tubulin, inhibiting microtubule assembly and causing mitotic arrest in the metaphase. The steroid component, often prednisolone or dexamethasone, exerts lympholytic effects by binding to the glucocorticoid receptor. This regimen has been primarily investigated by the German Low-Grade Lymphoma Study Group (GLSG) as an intensive treatment option for patients with advanced mantle cell lymphoma and other indolent B-cell non-Hodgkin lymphomas.
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