The tolerability of RIC makes it an attractive
preparative regimen for allo-HSCT, but the reduced dose or omission of cyclophosphamide, busulfan, and total body irradiation (TBI) raised concerns regarding the immunosuppressive and tumor-ablative potency.
Elias et al., "High-dose combination alkylating agent
preparative regimen with autologous bone marrow support: The Dana-Farber Cancer Institute/Beth Israel Hospital experience," Cancer Treatment Reports, vol.
Tepadina is approved to reduce the risk of graft rejection when used in conjunction with high-dose busulfan and cyclophosphamide as a
preparative regimen for allogeneic hematopoietic progenitor cell transplantation for pediatric patients with class 3 beta-thalassemia.
Several studies documented that reduced intensity
preparative regimen followed by stem cell infusion was associated with mixed chimerism and then full chimerism with a documented graft vs leukemia (GVL) effect in the setting of hematologic malignancies and graft versus tumor (GVT) effect in the setting of solid tumors (26-32).
"For the majority of unrelated transplants following a standard high-dose
preparative regimen, bone marrow should be used since survival is equivalent with two sources but the incidence of chronic graft-versus-host disease, which can be a debilitating complication, is significantly less with marrow," Dr.
Before the injection, patients undergo an immunodepleting
preparative regimen to eliminate competing T regulatory cells and lymphocytes.
The incidence of HC varies considerably according to the
preparative regimen, the preventative measures employed and perhaps the incidence of GVHD.
Because parking is not free at our facility, each patient receives two free books of parking passes when they start their
preparative regimen.
All recipients received the standard
preparative regimen involving cyclophosphamide (60 mg∙kg [sup]-1∙d [sup]-1 x 2, day −4, day −3) and total body irradiation (TBI) (5 Gy/day x 2, day −2, day −1).
Busulfan is a myeloablative agent that is used in combination with cyclophosphamide as a
preparative regimen for bone marrow transplantation; high-dose busulfan can be used as a substitute for total body irradiation.
The strengths of this study include looking at the kinetics of chimerism and not at just one point of time chimerism and a cohort of adult patients with only myeloid malignancies treated at a single center by the same physicians with uniform peripheral blood stem cell grafts and the widely used Bu based myeloablative
preparative regimens with the standard-of-care methotrexate/tacrolimus-based with or without antithymocyte globulin GVHD prophylaxis.
Moreover, HCT
preparative regimens used for AA are associated with unacceptable organ toxicity in DC patients, whereas newer, disease-specific
preparative regimens of reduced intensity have yielded improved outcomes.