Fludarabine + Busulfan conditioning regimen

Current understanding

To be populated as evidence accumulates.

Evidence log

• 2026-08-23 — Sequential High-Dose Ruxolitinib and Low-Dose Splenic Irradiation for Pretransplant Management of Splenomegaly Before Allogeneic Hematopoietic Cell Transplantation With Fludarabine/Busulfan-Based Conditioning in Myelofibrosis.: Retrospective series (observational): Flu/Bu served as the conditioning backbone in MF patients bridged with sequential high-dose ruxolitinib + low-dose splenic irradiation, with encouraging engraftment and early survival — supports Flu/Bu as a viable backbone when combined with aggressive pretransplant spleen debulking. (novelty: 3)
• 2026-05-20 — Venetoclax Added to Fludarabine + Busulfan Prior to Transplant and to Maintenance Therapy for AML, MDS, and MDS/MPN: Trial-early: a phase I/II trial is augmenting the FluBu conditioning backbone with venetoclax (and continuing venetoclax + azacitidine or ASTX727 as post-transplant maintenance) in AML/MDS/CMML/MDS-MPN-U, testing whether BCL-2 inhibition can be safely layered onto standard conditioning. (novelty: 3)
• 2026-05-15 — Chemotherapy (Decitabine in Combination With FLAG-Ida) and Total-Body Irradiation Followed by Donor Stem Cell Transplant for the Treatment of Adults With Myeloid Malignancies at High Risk of Relapse: Tangentially related: a phase I/II trial (trial-early) is evaluating decitabine + FLAG-Ida + TBI vs. FLAG-Ida + TBI as an alternative intensive conditioning backbone for high-risk myeloid malignancies (AML/MDS/CMML), representing a parallel non-FluBu conditioning strategy with HMA augmentation. (novelty: 3)
• 2026-05-15 — Prospective Single-Arm Clinical Study of Thiotepa-Containing Conditioning Regimen for Allogeneic Hematopoietic Stem Cell Transplantation in Chronic Myelomonocytic Leukemia: Trial-early: FluBu backbone is being intensified with thiotepa (± ATG) in a prospective single-arm trial of allo-HSCT conditioning for intermediate-2/high-risk CMML, exploring whether alkylator augmentation improves outcomes in this underserved subtype. (novelty: 3)
• 2026-04-03 — Fludarabine and Busulfan vs. Fludarabine, Busulfan and Total Body Irradiation: Trial-early: serves as the standard-of-care control arm in a randomized single-institution trial comparing FluBu vs. FluBu+low-dose TBI conditioning for allo-SCT in myeloid malignancies including MPNs, with relapse rate and transplant-related toxicity as primary endpoints. (novelty: 3)

Open questions

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