ICD-10 Specific code C95.0: Acute leukaemia of unspecified cell type

Aclarubicin is an anthracycline antibiotic produced by Streptomyces galilaeus and also has potent antineoplastic activity. It is less cardiotoxic than doxorubicin and daunorubicin. The mechanism of action of aclarubicin is based on its capacity to insert its trisaccharide chain into the minor DNA groove: poison of topoisomerase I, inhibitor of topoisomerase II, eviction of histones from nucleosomes, but also inhibitor of the 20S proteasome.

Ifosfamide is an antineoplastic, a cytotoxic alkylating agent. It is a prodrug and shows no in vitro cytotoxic activity until activated by microsomal enzymes. The cytotoxic activity of ifosfamide (alkylation of the nucleophilic centres in the cells) is associated with the activated oxazaphosphorine ring hydroxylated at the C4 atom which interacts with DNA-DNA cross linking. This activity manifests itself by blocking the late S and early G2 phases of the cell cycle.

Methotrexate (4-amino-10-methylfolic acid) is a folic acid antagonist which inhibits the reduction of folic acid and increase of tissue cells. Methotrexate enters the cell through an active transport mechanism of reduced folates. As a result of polyglutamation of methotrexate caused by the folylpolyglutamylate enzyme, the duration of the cytotoxic effect of the drug substance in the cell increases.

Thiotepa is a polyfunctional cytotoxic agent related chemically and pharmacologically to the nitrogen mustard. The radiomimetic action of thiotepa is believed to occur through the release of ethylene imine radicals that, as in the case of irradiation therapy, disrupt the bonds of DNA, e.g. by alkylation of guanine at the N-7, breaking the linkage between the purine base and the sugar and liberating alkylated guanine.

Vindesine is an antineoplastic agent derived from vinblastine, like the other vinca alkaloids it causes mitotic arrest in metaphase by binding to microtubular protein.