vincristine + dexamethasone + pegaspargase + daunorubicin + cyclophosphamide + cytarabine + mercaptopurine + methotrexate

This is a multi-agent **chemotherapy combination** used in pediatric protocols for high-risk **acute lymphoblastic leukemia (ALL)**, particularly during induction, consolidation, interim maintenance, and delayed intensification phases of Berlin-Frankfurt-Münster (BFM)-based regimens. It integrates **vincristine** (microtubule inhibitor disrupting mitosis), **dexamethasone** (glucocorticoid inducing apoptosis), **pegaspargase** (L-asparaginase depleting asparagine to starve leukemic cells), **daunorubicin** (anthracycline intercalating DNA and inhibiting topoisomerase II), **cyclophosphamide** (alkylating agent cross-linking DNA), **cytarabine** (antimetabolite inhibiting DNA polymerase), **mercaptopurine** (purine analog disrupting DNA/RNA synthesis), and **methotrexate** (folate antagonist inhibiting dihydrofolate reductase and DNA synthesis). Administered intravenously, intramuscularly, orally, and intrathecally, this regimen aims to eradicate minimal residual disease through synergistic cytotoxicity targeting proliferating lymphoblasts, with intrathecal components for CNS prophylaxis.[1][2][5]