Strategy of conditionning therapy for hematopoietic cell transplantation

Abstract

The rationale behind the use of different conditioning protocols in allotransplanted patients is given. Standard based on Busulfan (Bu) and Cyclophosphamide (Cy) chemotherapy protocol was used for good risk patients and those with a positive history of liver malfunction. In poor risk patients Bu and Cy was supported by ether Etoposide (VP-16) or Thiotepa. Toxicity of the VP-16 consiting chemotherapy was considerably higher than that of BuCy alone. This resulted in a higher transplant related mortality in VP-16 receiving patients. In aplastic anemias (AA) in children Cy was effective in a dose of 200 mg/kg b.w. given prior transplantation. In poor risk patients with severe AA anti-thymocyte globulin (ATG) was used. In Fanconi anemia ATG plus low dose of Cy proved to be succesful in 4 transplanted cases.