Reduced intensity conditioning refers to a conditioning regimen that uses less chemotherapy and radiation than the standard regimen, which destroys the patient's bone marrow cells, (a result known as myeloablation). The goal of using a reduced intensity conditioning regimen is to decrease the transplant-related complications, toxicity and mortality. However, since myeloablation may not be achieved with this approach, there may be a greater risk that that the transplanted cells will be rejected than in a full-intensity (myeloablative) conditioning regimen.
We offer two different reduced-intensity conditioning regimens. One uses busulfan, Fludarabine and anti-thymocyte globulin (ATG), which is an antibody made in rabbits and used to increase the likelihood of engraftment in bone marrow transplant recipients and to treat graft-versus-host disease (GvHD). This regimen is offered to patients with bone marrow failure syndromes, myelodysplastic syndrome, acute and chronic myeloid leukemias or metabolic disorders. The advantage of this regimen is that it reduces the incidence of disease and eliminates mortality during the conditioning regimen. The disadvantage is that the rate of transplant rejection may be higher than with a myeloablative regimen.
The other reduced intensity conditioning regimen uses Fludarabine, Melphalan, rabbit ATG and additional donor lymphocyte infusions post transplant. This regimen is offered to patients with acute leukemias who sustained organ damage from previous therapies. The advantage of this conditioning regimen is that it is safer than the myeloablative conditioning. We are currently investigating if donor lymphocyte infusions can reduce the risk of relapse after reduced intensity conditioning.
These regimes are used for patients with:
- Immune deficiencies or bone marrow failure defects, such as congenital neutropenia, thrombocytopenia and aplastic anemia
- Pre-leukemia syndromes, such as myelodysplastic syndrome and monosomy 7
- Acute myeloid leukemia (AML) in first remission or chronic myeloid leukemia (CML) in the chronic phase
- Metabolic disorders, such as Hurler's disease, metachromatic leukodystrophy and adrenal leukodystrophy
- Acute leukemia and dysfunction of the lung, heart or kidney or previous life-threatening infections or treatment complications
Currently, the non-myeloablative protocol is open to children who have the following:
- A related or unrelated donor including umbilical cord blood
- High-risk for a transplant-related toxic complication
- Leukemia or a non-malignant bone marrow disorder
- High risk leukemia and the inability to withstand a standard transplant using high-dose chemotherapy
Eventually, we hope to be able to offer this potentially safer approach to all bone marrow transplant patients.