FluBU (RIC)
Treatment Protocol for Second Allogeneic HSCT
Treatment Protocol
Day -6: Fludarabin 30 mg/m² IV
Day -5: Fludarabin 30 mg/m² IV + Busulfan 3.2 mg/kg IV
Day -4: Fludarabin 30 mg/m² IV + Busulfan 3.2 mg/kg IV
Day -3: Fludarabin 30 mg/m² IV
Day -2: Fludarabin 30 mg/m² IV
Day 0: Donor cell infusion
Post-Transplant GVHD Prophylaxis
Day +3: Cyclophosphamide 50 mg/kg IV
Day +4: Cyclophosphamide 50 mg/kg IV
Day +5: Tacrolimus 0.03 mg/kg/day IV or oral
Day +6: Mycophenolate mofetil 15 mg/kg oral (max 1 g twice daily)
Prophylactic Medications
- Bacterial Prophylaxis: Levofloxacin 500 mg/day until neutrophil engraftment.
- Fungal Prophylaxis: Posaconazole 300 mg/day during neutropenia and immunosuppression.
- Viral Prophylaxis: Acyclovir 400 mg/day for 3-6 months post-transplant.
- Pneumocystis jirovecii (PCP) Prophylaxis: Trimethoprim-Sulfamethoxazole twice weekly starting post-engraftment.
Follow-Up and Monitoring
- Regular monitoring of neutrophil and platelet engraftment (median neutrophil engraftment: Day +22).
- Daily assessment for acute GVHD signs (skin rash, diarrhea).
- Frequent infection screenings (blood cultures, imaging for fungal infections).