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This is a multi-agent conditioning regimen used prior to allogeneic hematopoietic stem cell transplantation (HSCT). It combines four drugs: - **Busulfan** (an alkylating agent that causes DNA cross-linking and cell death, primarily targeting rapidly dividing cells) - **Cyclophosphamide** (an alkylating agent with immunosuppressive and cytotoxic properties) - **Thymoglobulin** (rabbit anti-thymocyte globulin, a polyclonal antibody preparation that depletes T lymphocytes, reducing the risk of graft-versus-host disease) - **Fludarabine** (a purine analog antimetabolite that inhibits DNA synthesis and has immunosuppressive effects) This combination is designed to maximize myeloablation, immunosuppression, and prevention of graft rejection or graft-versus-host disease. The regimen is primarily used in patients undergoing allogeneic HSCT for hematologic malignancies such as acute myeloid leukemia or myelodysplastic syndromes. The addition of thymoglobulin aims to further reduce the incidence of acute and chronic GVHD compared to regimens without it[1][5][8].
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