temsirolimus + rituximab + fludarabine + cyclophosphamide

This is a combination regimen consisting of four agents: - **Temsirolimus** is an mTOR inhibitor that blocks the mammalian target of rapamycin pathway, leading to inhibition of cell growth and proliferation. - **Rituximab** is a monoclonal antibody targeting CD20 on B lymphocytes, resulting in B-cell depletion via immune-mediated mechanisms. - **Fludarabine** is a purine analog that inhibits DNA synthesis by interfering with DNA polymerase and ribonucleotide reductase, leading to apoptosis in rapidly dividing cells. - **Cyclophosphamide** is an alkylating agent that crosslinks DNA strands, preventing cell division and causing cell death. This combination has been studied primarily for relapsed or refractory mantle cell lymphoma (MCL) as part of immunochemotherapy regimens. The addition of temsirolimus to standard chemoimmunotherapy (such as R-FC-T: rituximab, fludarabine, cyclophosphamide plus temsirolimus) has shown activity but also increased toxicity. All patients in clinical trials experienced grade 3 or higher adverse events, mainly hematologic toxicities such as thrombocytopenia[1]. The regimen aims to combine targeted therapy (temsirolimus), immunotherapy (rituximab), and cytotoxic chemotherapy (fludarabine and cyclophosphamide) for synergistic antitumor effects.