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MA-BUCY2 is an intensified conditioning regimen developed by the First Affiliated Hospital of Xi'an Jiaotong University for patients with high-risk acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (haplo-HSCT). This regimen is a modification of the standard BUCY2 (Busulfan and Cyclophosphamide) protocol, incorporating mitoxantrone liposome, cytarabine (Ara-C), semustine (me-CCNU), and antithymocyte globulin (ATG). The addition of mitoxantrone liposome and high-dose cytarabine is intended to enhance the anti-leukemic effect and reduce the risk of relapse in high-risk populations. The regimen's mechanism of action involves a multi-pronged approach: DNA alkylation (via busulfan, cyclophosphamide, and semustine), DNA intercalation and topoisomerase II inhibition (via mitoxantrone), and DNA synthesis inhibition (via cytarabine), while ATG provides the necessary immunosuppression to prevent graft rejection and graft-versus-host disease (GVHD).
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