Bonnie J. Dirr, APRN: Dr Inyang, what are some of the various conditioning regimens used for patients receiving allogeneic stem cell transplantation other than the ones that Dr Gooptu just highlighted for us? Can you also share with our audience what regimens typically are used in your institute?

Eno-Abasi Inyang, PharmD, BCPS, BCOP: There are a number of regimens used, and the dosing varies depending on the conditioning intensity, such as myeloablative vs reduced-intensity conditioning. The conditioning regimens typically consist of a combination of chemotherapeutic agents and/or radiotherapy. For example, some of the lower- or reduced-intensity regimens can consist of TBI or total body irradiation, usually at a lower dose. Typically, that could be in the range of 200 to 400 grays [of radiation] plus a purine analog, and the most common that’s usually seen as fludarabine. Other regimens include an alkylating agent plus the purine analog. So, there being would be the purine and analog, and then the alkylating agent could be something like busulfan. Another regimen would be fludarabine plus melphalan, kind of as a third option that you’ll sometimes see for lower- and reduced-intensity conditioning regimens. For some higher-intensity myeloablative conditioning regimens, they can include TBI as well, but sometimes we’ll combine two alkylating agents by using busulfan and cyclophosphamide as a common regimen for myeloablative conditioning. [Also, an option is] using an alkaline agent such as busulfan and or cyclophosphamide plus TBI, and sometimes a TBI will be on the higher end of intensity, so it might be somewhere in the range of 800 to 1300 or 1320 grays. And then of course, you can use things like TBI plus busulfan plus cyclophosphamide as well.

At our institution, we typically use a combination of a purine analog and an alkylating agent—and again our primary purine analog is fludarabine, and our alkylating agent is usually busulfan. One e of our common regimens is fludarabine and busulfan, and we call it “FluBu”. We also do fludarabine and melphalan which we call “FluMel”. And then for MAC [myeloablative conditioning] gain, using combinations such as busulfan and cyclophosphamide is a common regimen. Occasionally we’ll throw a TBI in there as well as Dr Gooptu you talked about for ALL patients.

Transcript edited for clarity.