Conditioning Regimen

Currently, the combination of cyclophosphamide and antithymocyte globulin (ATG) is considered the best conditioning regimen for patients with a diagnosis of AA undergoing an HLA-identical related trans-plant.38'40'43 44 In a majority of studies, use of irradiation was associated with lower rejection rates but significantly higher TRM. A recent retrospective analysis by Ades et al. illustrates this40 (Figure 42.2). In the setting of alternate donors, such as MUD SCT, the optimal regimen remains to be defined. A publication by Deeg et al. suggests that cyclophoshamide with ATG may not be sufficient in this setting.45 The same group used escalating doses of TBI with cyclophosphamide a b a b

Time from transplantation (y) Time from transplantation (y)

Na at 133 85 68 57 47 43 25 7 No at 98 62 56 53 47 43 25 -

Figure 42.2 Overall survival. (a) Overall survival of 133 patients who underwent transplantation at the Hospital St. Louis (median follow-up of 13.6 years). (b) Overall survival according to the conditioning regimen with cyclophosphamide plus either antithymocyte globulin (Cy-ATG) or thoracoabdominal irradiation (Cy-TAI). (Reprinted from Ref. 40, used with permission.)

Time from transplantation (y) Time from transplantation (y)

Na at 133 85 68 57 47 43 25 7 No at 98 62 56 53 47 43 25 -

Figure 42.2 Overall survival. (a) Overall survival of 133 patients who underwent transplantation at the Hospital St. Louis (median follow-up of 13.6 years). (b) Overall survival according to the conditioning regimen with cyclophosphamide plus either antithymocyte globulin (Cy-ATG) or thoracoabdominal irradiation (Cy-TAI). (Reprinted from Ref. 40, used with permission.)

and ATG and concluded that the addition of 2-Gy TBI to cyclophosphamide and ATG was associated with the best result of 67% survival at 2 years.46 Use of Fludarabine-based and other RIC, both in the setting of related and alternate donors, remains to be evaluated in large studies.

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