rituximab + vincristine + doxorubicin + dexamethasone + chlorambucil

A multi-agent lymphoma chemotherapy regimen that combines the anti-CD20 monoclonal antibody rituximab with the cytotoxic agents vincristine and doxorubicin, plus the corticosteroid dexamethasone and the alkylating agent chlorambucil. Mechanistically, rituximab targets CD20 on B cells to mediate complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity; vincristine disrupts microtubule formation to arrest mitosis; doxorubicin intercalates DNA and inhibits topoisomerase II causing DNA breaks and free radical–mediated cytotoxicity; dexamethasone exerts lympholytic and anti-inflammatory effects via glucocorticoid receptor; chlorambucil alkylates DNA to impair replication and induce apoptosis. While widely used rituximab-based regimens include R-CHOP and R-Hyper-CVAD, a standardized regimen substituting chlorambucil for cyclophosphamide or prednisone is not commonly listed among established protocols; chlorambucil is more commonly seen in ChlVPP for Hodgkin lymphoma, and dexamethasone features in regimens like DHAP and Hyper-CVAD, indicating this combination is nonstandard or investigational.