Therefore, it seems that the increased cytotoxic effects of ICRP + CTX could be at least in some part due to the enhancement of mitochondrial alterations which can initiate cell death, similar to the results previously reported by combining Cfz + Dex which showed a significant increase in caspase 3, BAX and BCL2 gene expression in a T-ALL cell line compared to monotherapy [33]. Here, CASP3 is linked to acute lymphoblastic leukemia.