Version May 2024
| Regimen | Dosing | Comments |
| Myeloablative regimens | ||
| A myeloablative regimen is expected to destroy the hematopoietic cells in the bone marrow and result in profound pancytopenia within one to three weeks from the time of administration. Suppression of the host's immune system is also important to prevent graft rejection. The resulting pancytopenia is long-lasting, usually irreversible, and in most instances fatal, unless hematopoiesis is restored by infusion of hematopoietic stem cells. | ||
| BEAM | The BEAM regimen combines carmustine (BCNU, 300 mg/m2) over one day, etoposide (400 to 800 mg/m2) over four days, cytosine arabinoside (800 to 1600 mg/m2) over four days, and melphalan (140 mg/m2) over one day | BEAM is the most commonly employed myeloablative preparative regimen for patients with non-Hodgkin or Hodgkin lymphoma. |
| Cy/TBI | The Cy/TBI regimen combines cyclophosphamide 120 mg/kg total dose administered over two days with total body irradiation (TBI, 12 to 14 Gy) administered over four days | TBI/Cy is an alternative where the TBI is given first, followed by cyclophosphamide. Other regimens include etoposide (60 mg/kg) instead of cyclophosphamide or in addition to cyclophosphamide for patients with advanced disease not in remission. |
| Bu4/Cy | The Bu4/Cy regimen combines intravenous busulfan 12.8 mg/kg total dose administered over four days with cyclophosphamide 120 mg/kg administered over two days | |
| Flu/Bu4 | The Flu/Bu4 regimen combines intravenous busulfan 12.8 mg/kg total dose with fludarabine 120 to 180 mg/m2, each administered over four days | |
| High dose melphalan | Melphalan (200 mg/m2) | Commonly employed as the preparative regimen prior to autologous HCT for multiple myeloma. A lower dose (eg, 140 mg/m2) should be used in older patients (ie, >70 years), those with renal dysfunction, or patients with multiple comorbidities. |
| CBV | The CBV regimen combines a single dose of carmustine (300 to 500 mg/m2) followed by both etoposide (600 to 2400 mg/m2) and cyclophosphamide (4.8 to 7.2 g/m2) administered over four days | Commonly employed as a preparative regimen for patients with lymphoma undergoing autologous transplant. |
| Reduced intensity regimens | ||
| Reduced intensity conditioning regimens are an intermediate category of regimens that do not fit the definition of myeloablative or nonmyeloablative. Such regimens cause cytopenias, which may be prolonged and result in significant morbidity and mortality, and require hematopoietic stem cell support. These regimens are tailored to suppress the host's immune system to allow engraftment. | ||
| Flu/Mel | Fludarabine (125 to150 mg/m2 total dose) administered over five days with melphalan (140 mg/m2) administered over two days | |
| Flu/Bu2 and Flu/Bu3 | Fludarabine (150 to 160 mg/m2 total dose) administered over four to five days with oral busulfan (8 to 10 mg/kg) administered over two to three days | |
| Flu/Cy | Fludarabine (150 to 180 mg/m2 total dose) administered over five to six days with cyclophosphamide (120 to 140 mg/kg) administered over two days | |
| Flu/Bu3/TT | Fludarabine 150 mg/m2 total dose administered over three days with busulfan (8 mg/kg) administered over three days and thiotepa (5 to 10 mg/m2) over one to two days, respectively | |
| Nonmyeloablative regimens | ||
| A nonmyeloablative regimen is one that will cause minimal cytopenia (but significant lymphopenia) by itself and does not require stem cell support. However, the transplant, when given in this setting, usually becomes myeloablative because the engrafting donor T cells will eventually eliminate host hematopoietic cells, allowing the establishment of donor hematopoiesis. | ||
| Flu/TBI | Fludarabine 90 mg/m2 total dose administered over three days with low dose total body irradiation (TBI, 2 Gy) administered on the day of graft infusion | |
| TLI/ATG | Total lymphoid irradiation (TLI, 8 to 12 cGy) administered over 11 days with anti-thymocyte globulin (ATG; 1.25 mg/kg) administered over five days | TLI and anti-thymocyte globulin appear to alter the host immune profile to favor regulatory natural killer T cells that suppress GVHD but retain graft antitumor activity. |
| Low dose TBI | Low dose TBI can be administered at a dose of 1 to 2 Gy on the day of graft infusion | |
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