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Fludarabine + anti-thymocyte globulin + busulfan (Flu/ATG/Bu or FBx-ATG) is a reduced-intensity or reduced-toxicity conditioning regimen used prior to allogeneic hematopoietic stem cell transplantation (HSCT). The regimen combines three distinct agents to prepare the recipient's bone marrow and immune system for donor engraftment: fludarabine, a purine nucleoside analog that acts as a lymphodepleting antimetabolite; anti-thymocyte globulin (ATG), a polyclonal antibody biologic that depletes T cells to prevent graft rejection and graft-versus-host disease (GvHD); and busulfan, a bifunctional alkylating agent that cross-links DNA to achieve myeloablation. This combination is widely utilized in the transplantation process for both malignant hematologic conditions (such as acute myeloid leukemia, myelodysplastic syndromes, and lymphomas) and non-malignant disorders (including severe aplastic anemia, sickle cell disease, and Fanconi anemia).
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