venetoclax + azacitidine + homoharringtonine + cytarabine + granulocyte colony-stimulating factor

This five-drug combination regimen, often referred to as VA-HAG, is an intensive salvage therapy for patients with relapsed or refractory acute myeloid leukemia (AML). It integrates the BCL-2 inhibitor venetoclax and the hypomethylating agent azacitidine with the HAG regimen, which consists of homoharringtonine, low-dose cytarabine, and granulocyte colony-stimulating factor (G-CSF). Venetoclax induces apoptosis by inhibiting the anti-apoptotic protein BCL-2, while azacitidine acts as a DNA methyltransferase inhibitor to reverse epigenetic silencing. Homoharringtonine prevents protein synthesis by binding to the ribosomal A-site, and cytarabine acts as an antimetabolite that interferes with DNA synthesis. G-CSF is included to stimulate the proliferation of quiescent leukemia blasts, thereby increasing their sensitivity to the cytotoxic effects of cytarabine and homoharringtonine, while also accelerating neutrophil recovery. This regimen is primarily being evaluated in clinical trials sponsored by institutions such as The People's Hospital of Jiaozuo City.

Other names

VA-HAG regimenVenetoclax plus Azacitidine plus HAG