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This is a specific myeloablative preparative regimen developed by St. Jude Children's Research Hospital for use in pediatric and young adult patients with high-risk hematologic malignancies undergoing umbilical cord blood transplantation (UCBT). The regimen is designed to achieve profound myeloablation and immunosuppression to facilitate donor stem cell engraftment while eradicating residual malignant cells. It consists of a combination of the purine analog fludarabine (75 mg/m²), fractionated total body irradiation (TBI) at a dose of 10.0 to 12.0 Gy, and the alkylating agent cyclophosphamide (120 mg/kg). The regimen also includes the administration of mesna as a uroprotective agent to prevent hemorrhagic cystitis associated with high-dose cyclophosphamide. This protocol is typically evaluated in Phase 2 clinical trials for patients who lack a suitable HLA-matched related or unrelated donor.
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