busulfan + melphalan + fludarabine

This conditioning regimen is a combination of three chemotherapy agents—busulfan, melphalan, and fludarabine—developed and evaluated by Memorial Sloan Kettering Cancer Center (MSKCC) for patients with relapsed or high-risk multiple myeloma. It is utilized as a reduced-toxicity myeloablative preparation prior to T-cell depleted allogeneic hematopoietic stem cell transplantation (allo-HSCT). The regimen combines the DNA-alkylating properties of busulfan and melphalan with the purine analog fludarabine to provide potent cytoreduction of malignant plasma cells while facilitating donor cell engraftment. In clinical practice, it is typically administered alongside anti-thymocyte globulin (ATG) to prevent graft rejection and is followed by donor lymphocyte infusions (DLI) to promote a graft-versus-myeloma effect while minimizing the risk of graft-versus-host disease (GVHD).

Other names

BMF regimenBu/Mel/Flubusulfan + melphalan + fludarabine + ATG