Feasibility of an Intensified Myeloablative Conditioning Regimen Consisting of Busulfan, Fludarabine, Cytarabine, and Total Body Irradiation

In a recent article published in the International Journal of Hematology, researchers at the Kumamoto University Hospital in Kumamoto, Japan have developed a new method for cord blood transplantation (CBT) in elderly patients. Using a combination of radiation and three drugs, the researchers were able to achieve hematological recovery, low incidence of relapse, and higher probability of disease-free survival (DFS).


Allogeneic hematopoietic stem cell transplantation (allo-HCT) is currently used to treat certain types of blood cancers. Unfortunately, elderly patients undergoing allo-HCT present significant challenges in acquiring an HLA-matched sibling and have a higher risk of cytogenetic abnormalities. Using cord blood instead of an HLA-matched donor provides an alternative source of transplantable material for elderly patients.


This study examined a novel protocol for CBT using fludarabine, intravenous busulfan, cytarabine, and 4-Gy total body irradiation before transplantation in patients older than 55 years. In total, 33 patients with a median age of 64 years (range 56–70) were included in the study. Using this protocol, DFS was found to be 57% three years after CBT, compared to an average DFS of 30-40% for allo-HCT. Although further studies are required to confirm these findings, suggest improved treatment efficacy.



Kawakita T, Hirano T, Inoue Y, et al. Feasibility of an intensified myeloablative conditioning regimen consisting of busulfan, fludarabine, cytarabine, and total body irradiation before single cord blood transplantation in elderly patients. Int J Hematol. 10.1007/s12185-021-03131-9. 2021.


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