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This is a multi-agent conditioning regimen used prior to allogeneic hematopoietic cell transplantation, particularly for patients with hematologic malignancies such as acute myeloid leukemia and acute lymphoblastic leukemia. The regimen combines two nucleoside analogs—fludarabine and clofarabine—which inhibit DNA synthesis and repair, leading to complex DNA damage in malignant cells. Busulfan, an alkylating agent, further induces DNA cross-linking and cytotoxicity. Antithymocyte globulin (ATG) is included for immunosuppression to prevent graft rejection by depleting host T-cells. Total body irradiation (TBI) provides additional myeloablative effect and immunosuppression. This combination aims to maximize cytoreduction of malignant cells while providing sufficient immunoablation for successful engraftment[1][2][6].
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