carmustine + cytarabine + etoposide + melphalan + Thymoglobulin

This is a combination regimen consisting of four chemotherapeutic agents—carmustine, cytarabine, etoposide, and melphalan—plus Thymoglobulin (anti-thymocyte globulin [rabbit]). The combination is used as part of conditioning regimens for hematopoietic stem cell transplantation or in other settings requiring profound immunosuppression and myeloablation.

• Carmustine is an alkylating agent that crosslinks DNA and RNA, inhibiting replication and transcription.
• Cytarabine is a nucleoside analog that inhibits DNA synthesis by acting as an antimetabolite.
• Etoposide inhibits topoisomerase II, leading to DNA strand breaks.
• Melphalan is another alkylating agent causing crosslinking of DNA strands.
• Thymoglobulin (anti-thymocyte globulin [rabbit]) is a polyclonal antibody preparation that depletes T lymphocytes via multiple mechanisms including complement-dependent lysis and apoptosis.

The overall effect of this regimen is profound immunoablation (via T-cell depletion) combined with myeloablation (via chemotherapy), which prepares the patient for stem cell transplantation or treats certain hematologic malignancies.