Flu Bu ATG for Haplo
- Busulfan (Busulfex, Otsuka Pharmaceuticals) 3.2 mg/kg per day intravenously on days −7 and −6
- Fludarabine 30 mg/m2 per day intravenously on days −7 to −2
- Rabbit ATG (thymoglobulin, Genzyme Transplant) 3 mg/kg per day on days −4 to −1
Stem cell collection
Starting on day −3, each hematopoietic cell donor was given granulocyte colony-stimulating factor (G-CSF) 10 μg/kg per day subcutaneously for 4 to 5 days. Starting on the fourth day (day 0 of HCT) of G-CSF administration, donor mononuclear cells were harvested by large-volume leukapheresis, with the goal of collecting at least 5 × 106 CD34+ cells per kilogram of recipient body weight. The collected cells were administered on the same day to the designated patient through a central venous catheter. Sixty-eight donors (82%) required cell collections on 2 days (days 0 and 1), 13 (16%) required 3 collections, and 1 each required 4 and 5 collections.
GVHD prophylaxis and supportive care
For GVHD prophylaxis, patients were given cyclosporine 1.5 mg/kg intravenously every 12 hours starting on day −1, and subsequently switched to a 1.5- to 2-fold greater oral dose of cyclosporine. The blood concentrations of cyclosporine were monitored at least once weekly and were referenced to 100 to 300 ng/mL. In addition, patients received methotrexate 15 mg/m2 intravenously 1 day and 10 mg/m2 3, 6, and 11 days after the last donor cell infusion. The dose of cyclosporine was halved if serum creatinine concentration increased to twice the baseline level and was discontinued if the concentration rose to 3 times the baseline level. The dose of methotrexate was halved if serum creatinine concentration increased to twice the baseline level or if a patient developed a grade 2 hepatic toxicity or stomatitis, and was withheld if serum creatinine increased to 3 times the baseline level or if a patient developed grade 3 hepatic toxicity or stomatitis. Starting 30 to 60 days after HCT, the cyclosporine dose was decreased by 10% every 2 to 4 weeks in patients with no evidence of GVHD. In 7 patients who were transplanted after September 2009, the last dose of methotrexate was omitted.