case_images: PMC11751042_01
case_images: Conditioning regimen for the first transplant (RIC) (A), the second transplant (MAC) (B), and the haploidentical hematopoietic stem cell transplant (C). (A) Fludarabine (30 mg/m^2/day x 5 days), Melphalan (70 mg/m^2/day x 2 days), ATG Rabbit; Thymoglobulin (2.5 mg/kg/day from days -4 to -1). (B) Busulfan (16 doses; 3.8 mg/kg/day), Fludarabine (30 mg/m^2/day x 5 days), ATG Rabbit; Thymoglobulin (2.5 mg/kg/day from days -4 to -1), Methotrexate (15 mg/m2/day on +1 and 10 mg/m2/day on +3, +6, +11). (C) Thiotepa (5 mg/kg/day x 2 days), Busulfan (8 doses; 3.8 mg/kg/day), Cyclophosphamide (10 mg/kg/day x 2 days), ATG Horse; ATGAM (10 mg/kg/day x 2 days), PTCY (50 mg/kg/day x 2 days).
case_images: fimmu-15-1475448-g001.jpg
case_images: PMC11751042_01_fimmu-15-1475448-g001.jpg
case_images: f1
case_images: Rabbit anti-human thymocyte globulin (ATG-Thymoglobuline, 2.5 mg/kg/day from days -4 to -1) was added to prevent rejection, and the graft-versus-host disease (GvHD) prophylaxis included cyclosporine A ( Figure 1A ). The GvHD prophylaxis included Cyclosporine A and a short course of methotrexate (MTX) ( Figure 1B ). This intensified conditioning regimen and increased cell dose aimed to overcome the previous graft failure and achieve successful engraftment. To prevent GvHD, the patient received post-transplant cyclophosphamide (PTCY; 40 mg/kg/day x 2 days) and cyclosporine A ( Figure 1C ). This haploidentical HSCT with an intensified RIC regimen was the next step in attempting to achieve successful engraftment and reconstitution of the patient's hematopoietic system after the previous graft failures.