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Chemotherapeutic Agents Used in Stem Cell Transplant

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Basics of Hematopoietic Stem Cell Transplant

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Abstract

Multiple factors have to be considered when a patient is planned for stem cell transplant (SCT). One of the most important parameters to be decided is the most suitable conditioning regimen for a given patient. There is unfortunately no perfect guide to suggest the best conditioning regimen that can control the disease as well as have minimum complications. Selection of conditioning regimen and dosing of agents may need to be individualized for each patient to minimize the toxicities and to achieve the best outcome. Compared to a lower intensity conditioning regimen (reduced intensity or non-myeloablative), a higher intensity regimen (myeloablative) is associated with more non-relapse mortality but less risk of relapse. Socioeconomic and demographic factors are also likely to influence the decision about SCT. The two arms of conditioning regimens are myeloablation and lymphoablation. Busulfan (Bu) is an alkylating agent and most effective on myeloid-erythroid axis, with minor effect on the lymphoid system and causes little immunosuppression. Cyclophosphamide (Cy) has immunosuppressive properties and is combined with Bu or total body irradiation (TBI) for SCT-conditioning regimens. Cy has been replaced with fludarabine (Flu), an immunosuppressive agent, to provide a less toxic but equally effective regimen. Flu has become one of the most commonly used immunosuppressive agent in nearly all types of conditioning regimens being either myeloablative, reduced intensity or non-myeloablative. The treosulfan has replaced Bu in most of the transplant protocols. It has immunosuppressive effects and low extramedullary toxicity. Thiotepa is chemically and pharmacologically related to nitrogen mustards and has good central nervous system penetration and is also being increasingly used. An in-depth knowledge about the risks and benefits of the combination of agents used in the SCT is necessary for the best outcome of SCT.

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  1. Department of Hemato-oncology and Bone Marrow Transplantation, Venkateshwar Hospital, New Delhi, Delhi, India

    Sanjeev Kumar Sharma

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  1. Sanjeev Kumar Sharma
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© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

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Sharma, S.K. (2023). Chemotherapeutic Agents Used in Stem Cell Transplant. In: Basics of Hematopoietic Stem Cell Transplant. Springer, Singapore. https://doi.org/10.1007/978-981-19-5802-1_17

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  • DOI: https://doi.org/10.1007/978-981-19-5802-1_17

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-5801-4

  • Online ISBN: 978-981-19-5802-1

  • eBook Packages: MedicineMedicine (R0)

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