Reducedintensity Conditioning Regimens

Most reduced-intensity conditioning regimens have combined purine analogs (fludarabine, cladribine, or pentostatin) and alkylating agents, usually cyclophos-phamide, busulfan, or melphalan. In 1997, Giralt et al. reported engraftment of HLA-identical related transplants after a reduced-intensity conditioning regimen combining fludarabine 30 mg/m2/day X 4 days, cytarabine zg/m2/day X 4 days, and idarubicin 12 mg/m2/day X 3 days.6 Initial engraftment was greater than 90% with TRM around 20%. Giralt et al. subsequently reported a more intense regimen combining fludarabine (120-125 mg/m2) and melphalan (140-180 mg/m2) for patients with advanced leukemia, multiple myeloma, or renal cell carcinoma.34 Nonrelapse mortalities at 100 days and 1 year after the transplant were around 20 and 40%, respectively.34 The Jerusalem group developed another protocol combining fludarabine, antithymocyte globulin (ATG), and low-dose oral busulfan.7 This regimen allowed the achievement of full donor chimerism in the majority of the patients with a low TRM. However, most patients included in this study were younger and would be considered eligible for conventional allo-geneic HCT. Kottaridis et al. used another regimen combining Campath-1H (100 mg/m2), melphalan (140 mg/m2), and fludarabine (150 mg/m2).35'40 This regimen allowed engraftment with low incidences of GvHD and TRM in HLA-matched related and unrelated recipients.

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