1. Conditioning for transplantation.
| Medicinal product | MSD‐HSCT1 | Bayever 1984 | Führer 2005 |
| Dose and duration of therapy | |||
| Cyclophosphamide | 50 mg/kg/day for 4 days (‐5, ‐4, ‐3, ‐2); BMT preparative regimen | Yes, as recommended | Yes, as recommended |
| Antithymocyte globulin | 30 mg/kg/day for 3 days (‐5, ‐4, ‐3); horse ATG; BMT preparative regimen | NR | Führer 1998 reports antilymphocyte globulin 0.75 ml/kg/day for 4 days Führer 2005 reports horse ATG 0.75 ml/kg/day for 4 days |
| Methylprednisolone | 2 mg/kg/day for 3 days (‐5, ‐4, ‐3); BMT preparative regimen; usually not used for children | Yes, 2 mg/kg/day prednisone in patients who developed acute GVHD of grade 2 or higher | NR |
| Methotrexate | 15 mg/m2/day for 1 day (+1) and 10 mg/m2/day for 3 days (+3, +6, +11); BMT post‐transplant immunosuppression | Yes, as recommended | NR Führer 1994 (protocol): methotrexate was planned |
| Ciclosporin | 5 mg/kg/day; BMT post‐transplant immunosuppression; starting on day ‐1 continued for 12 months with tapering beginning at 9 months; Marsh 2009 | NR | NR Führer 1994 (protocol): ciclosporin was planned |
| Irradiation2 | Radiation‐based regimens should be avoided | 3 Gy total body irradiation on day ‐1 | NR Führer 1994 (protocol): irradiation was not planned |
1Recommended dose and duration of therapy according to Schrezenmeier 2000 unless indicated.
2Schrezenmeier 2000: "While irradiation‐based programs have been effective in reducing rejection, they have accomplished their goal at the price of more transplant‐related complications. A combination of cyclophosphamide and antithymocyte globulin was found as effective as irradiation in preventing rejection with better long‐term outcome. In regards to conditioning regimens, radiation‐based regimens should be avoided because of the higher associated likelihood of inducing secondary cancer, the deleterious effects on fertility, and the potential detrimental effects on growth and development, a policy that would be particularly important for pediatric patients."
Abbreviation: ATG: antithymocyte globulin; BMT: bone marrow transplantation; GVHD: graft‐versus‐host disease; Gy: Gray; MSD‐HSCT: first‐line allogeneic hematopoietic stem cell transplantation from HLA‐matched sibling donor; NR: not reported