Second transplant for a thalassemia patient after graft rejection: with immunosuppression and allogeneic peripheral blood stem cell

A 13-year-old girl suffering from β-thalassaemia major received bone marrow transplantation (BMT) from her HLA identical brother. After initial engraftment, she developed mixed chimerism. Secondary graft rejection occurred at 10 months after BMT and resulted in marrow aplasia. A second transplant with the same bone marrow donor was performed. The patient was conditioned with antithymocyte globulin 90 mg/kg followed by peripheral blood stem cell infusion. There was prompt engraftment and patient reverted to complete chimerism. There were no severe treatment-related complications or acute or chronic graft versus host disease after second transplant. The patient remained transfusion independent at 26 months after second transplant.