Thiotepa + Busulfan + Fludarabine (± ATG) conditioning regimen (CMML)

Current understanding

A thiotepa-containing conditioning regimen (thiotepa + busulfan + fludarabine, with or without ATG) is being prospectively evaluated as a conditioning strategy for allo-HSCT in intermediate-2 / high-risk chronic myelomonocytic leukemia (CMML), a disease where transplant conditioning evidence is sparse. Current data are at the trial-early stage (prospective single-arm clinical study), with efficacy and safety endpoints still pending. The rationale rests on thiotepa’s CNS-penetrant alkylating activity layered onto a standard FluBu backbone to deepen disease control before engraftment.

Evidence log

• 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: cross-connection with decitabine-flag-ida-tbi-conditioning: Parallel conditioning intensification strategies for CMML allo-HSCT: thiotepa-augmented FluBu vs. decitabine-augmented FLAG-Ida+TBI, both testing whether adding a fourth agent to standard backbones reduces relapse. (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: cross-connection with fludarabine-busulfan-conditioning: Thiotepa/Bu/Flu builds directly on the FluBu backbone, adding an alkylator for CMML-specific conditioning. (novelty: 3)

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