Pretransplantation Preparative Regimens
Pretransplantation conditioning is used both for the purpose of eradicating disease and as a means of immunosuppressing the recipient sufficiently to allow the acceptance of a new immunologically disparate hematopoietic system. The current mainstay of the preparatory regimen for HSCT consists of ablative doses of total body irradiation (TBI) and cyclophosphamide or busulfan (Bu) and cyclophosphamide. Table 25-8 shows various preparative regimens. On completion of the preparative regimen, the donor marrow, PBSC, or UCB is infused. During the subsequent pan-cytopenic period, supportive care is critical.
Two preconditioning regimes, which have antitumor as well as immunosuppressive properties, are commonly used prior to stem cell transplantation. TBI (fractionated doses) and cyclophosphamide are utilized in ALL. A combination of TBI and cyclophosphamide or cyclophosphamide and busulfan is utilized in AML, CML, myelodysplasia, JCML, and JMML as follows:
1. Total body irradiation (TBI) and cyclophosphamide:
Day Schema I
-8 TBI 150 cGy twice daily
-7 TBI 150 cGy twice daily
-6 TBI 150 cGy twice daily
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