Book contents
- Frontmatter
- Contents
- Acknowledgments
- Contributor
- 1 Rationale for transplantation
- 2 Types of transplantation
- 3 Human leukocyte antigen matching in allogeneic transplantation
- 4 Stem cell source
- 5 Pretransplant evaluation and counseling of patient and donor
- 6 Conditioning regimens
- 7 Stem cell infusion
- 8 ABO compatibility
- 9 Engraftment
- 10 Preventative care
- 11 Transplant-related complications
- 12 Overview of acute and chronic graft-versus-host disease
- 13 Acute graft-versus-host disease and staging
- 14 Graft-versus-host disease prophylactic regimens
- 15 Treatment guidelines for acute graft-versus-host disease
- 16 Chronic graft-versus-host disease
- 17 Engraftment syndrome
- 18 Infectious disease
- 19 Graft rejection and failure
- 20 Gastrointestinal complications
- 21 Oral health in stem cell transplantation
- 22 Pulmonary complications
- 23 Veno-occlusive disease
- 24 Special transfusion-related situations
- 25 Cardiovascular complications
- 26 Neurologic complications
- 27 Cystitis
- 28 Donor lymphocyte infusion
- 29 Transplantation: regulation and accreditation
- Index
- References
6 - Conditioning regimens
Published online by Cambridge University Press: 05 November 2013
- Frontmatter
- Contents
- Acknowledgments
- Contributor
- 1 Rationale for transplantation
- 2 Types of transplantation
- 3 Human leukocyte antigen matching in allogeneic transplantation
- 4 Stem cell source
- 5 Pretransplant evaluation and counseling of patient and donor
- 6 Conditioning regimens
- 7 Stem cell infusion
- 8 ABO compatibility
- 9 Engraftment
- 10 Preventative care
- 11 Transplant-related complications
- 12 Overview of acute and chronic graft-versus-host disease
- 13 Acute graft-versus-host disease and staging
- 14 Graft-versus-host disease prophylactic regimens
- 15 Treatment guidelines for acute graft-versus-host disease
- 16 Chronic graft-versus-host disease
- 17 Engraftment syndrome
- 18 Infectious disease
- 19 Graft rejection and failure
- 20 Gastrointestinal complications
- 21 Oral health in stem cell transplantation
- 22 Pulmonary complications
- 23 Veno-occlusive disease
- 24 Special transfusion-related situations
- 25 Cardiovascular complications
- 26 Neurologic complications
- 27 Cystitis
- 28 Donor lymphocyte infusion
- 29 Transplantation: regulation and accreditation
- Index
- References
Summary
Conditioning regimens aredesigned to destroy tumor cells resistant to conventional doses ofchemotherapy without causing fatal nonhematologic organ toxicity. Inpatients undergoing allogeneic stem cell transplantation, conditioningregimens must be sufficiently immunosuppressive to prevent the recipientfrom mounting an immune response capable of rejecting the graft. Graftrejection is uncommon, but this complication is associated with a direoutcome and the risk increases with the degree of mismatch.
There are few randomizedtrials comparing different ablative regimens; in general, increasedintensity of the conditioning regimen may decrease relapse rates, butusually (though not always) at the expense of increased nonrelapse morbidityand mortality. The following represent some of the more common regimens usedtoday, although different combinations and doses may be used at differentcenters. It is essential to check the specific protocol that applies to thepatient for drugs, doses, frequency, and other specifics of treatments.Biologic agents such as Campath® or antithymocyte globulin (ATG)may be added to enhance immunosuppression. See Appendix for ideal bodyweight (IBW) and adjusted ideal body weight (AIBW) for obese patients. Table6.1 summarizes currently used regimens.
- Type
- Chapter
- Information
- Manual of Stem Cell and Bone Marrow Transplantation , pp. 21 - 30Publisher: Cambridge University PressPrint publication year: 2013