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.