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This is a four-drug combination regimen consisting of venetoclax, cytarabine, aclarubicin, and granulocyte colony-stimulating factor (G-CSF), commonly referred to as VD-CAG or VA-CAG. Venetoclax is a selective BCL-2 inhibitor that promotes apoptosis in malignant cells by inhibiting the anti-apoptotic protein BCL-2. Cytarabine is an antimetabolite chemotherapeutic agent that inhibits DNA synthesis by acting as a cytosine nucleoside analog. Aclarubicin is an anthracycline antibiotic with antitumor activity primarily through inhibition of topoisomerase II and generation of free radicals leading to DNA damage; it also affects topoisomerase I and has additional antiproliferative effects[7]. Granulocyte colony-stimulating factor (G-CSF) stimulates the production and differentiation of neutrophils from bone marrow progenitors. The combination has been studied as induction therapy for newly diagnosed acute myeloid leukemia (AML), particularly in elderly or unfit patients who are not candidates for intensive chemotherapy[2]. Clinical studies have shown high rates of complete remission and measurable residual disease negativity with this regimen[1][2].
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