thiotepa + busulfan + fludarabine + anti-thymocyte globulin

The TBF regimen is a reduced-toxicity conditioning (RTC) protocol consisting of thiotepa, busulfan, fludarabine, and anti-thymocyte globulin (ATG). Developed and evaluated by Assistance Publique - Hôpitaux de Paris (AP-HP), this combination is used as a preparative treatment for adults with high-risk myeloid malignancies—including acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), and chronic myelomonocytic leukemia (CMML)—prior to undergoing unrelated cord blood transplantation (CBT). Thiotepa and busulfan act as potent alkylating agents that create DNA crosslinks to provide myeloablation and anti-leukemic activity, while fludarabine serves as an antimetabolite to inhibit DNA synthesis. Anti-thymocyte globulin is included to provide essential immunosuppression, facilitating the engraftment of hematopoietic stem cells and reducing the risk of graft rejection. The TBF regimen is designed to optimize the balance between anti-tumor efficacy and transplant-related toxicity, specifically aiming to lower non-relapse mortality (NRM) in the cord blood transplant setting.

Other names

TBF regimenTBF conditioningTBF conditioning regimenReduced Toxicity Conditioning TBF