vincristine + prednisone + daunorubicin + nelarabine + asparaginase + methotrexate + cyclophosphamide + cytarabine + mercaptopurine + dexamethasone + pegaspargase + thioguanine

This multi-agent chemotherapy regimen, developed by the **Children's Oncology Group (COG)** in collaboration with the **National Cancer Institute (NCI)**, is a specialized protocol for the treatment of newly diagnosed T-cell acute lymphoblastic leukemia (T-ALL) in children and young adults. The regimen is characterized by the addition of **nelarabine**, a purine nucleoside antimetabolite, to an augmented Berlin-Frankfurt-Muenster (BFM) chemotherapy backbone. It utilizes a diverse array of mechanisms to maximize leukemic cell clearance, including tubulin inhibition (vincristine), DNA alkylation (cyclophosphamide), DNA intercalation and topoisomerase II inhibition (daunorubicin), antimetabolite activity (methotrexate, mercaptopurine, thioguanine, cytarabine, nelarabine), asparagine depletion (asparaginase, pegaspargase), and glucocorticoid-mediated apoptosis (prednisone, dexamethasone). Clinical results from the Phase III AALL0434 trial demonstrated that the inclusion of nelarabine significantly improved disease-free survival in pediatric and young adult patients with T-ALL.

Other names

COG T-ALL RegimenNelarabine-augmented BFM regimenAugmented Berlin-Frankfurt-Muenster plus Nelarabine