IACH News of the Month:

Hematopoietic Stem Cell Transplantation (HCT)

June 30, 2026
Prepared by Dr. Fabio A. Torres and Dr. Mateo Mejía S.

Novel FABT-Based Conditioning Regimen With Haploidentical Transplantation for Severe Aplastic Anemia: A Prospective, Single-Center, Phase II Clinical Trial

Highlights:

●      The incorporation of thiotepa into a conditioning protocol for aplastic anemia (AA) serves as both an immunosuppressive and myeloablative agent that helps improve stem cell engraftment without increasing stem cell depletion.

●      A novel “dual blockade” approach to prevent graft-versus-host disease (GVHD) by combining low-dose antithymocyte globulin (ATG) with post-transplant cyclophosphamide (PTCy) resulted in a significantly low incidence of severe GVHD and complete prevention of primary and secondary graft failure (GF).

While matched sibling donor transplantation is the preferred first-line curative therapy for severe aplastic anemia (SAA), many patients lack a suitable HLA-identical sibling donor. Historically, the use of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) as an alternative has been hindered by two major hurdles: GF and severe GVHD. Current “mainstream” protocols for conditioning (Beijing and Baltimore protocols) can cause significant damage to non-hematopoietic organs (such as the gonads) and lead to toxicities like hepatic insufficiency, oral mucositis, and gastrointestinal reactions. A recent prospective, single-center, single-arm, phase II clinical trial in China evaluated a novel FABT regimen (fludarabine, ATG, busulfan, and thiotepa) designed to address these specific problems by improving engraftment rates and reducing the incidence of GVHD and viral infections. The evaluation of this protocol in 36 patients demonstrated high efficacy and a favorable safety profile for patients with SAA undergoing haplo-HSCT. After a median follow-up period of 21 months (range 2-30), the 2-year overall survival (OS) and GVHD-free, relapse-free survival was 91.7%. The most notable statistically significant result was the impact of age on survival. Patients ≤40 years old (n=20) achieved a 2-year OS of 100%, which was significantly higher than the 81.3% observed in patients >40 years old (p=0.047). The combination of low-dose ATG (2 mg/kg/day) and PTCy effectively managed GVHD. The cumulative incidence of grade II to IV acute GVHD was only 8.3%. Similarly, the incidence of chronic GVHD was 11.1%, and notably, all cases were mild and limited to the skin. The regimen was generally well-tolerated, with no deaths attributed to regimen-related toxicity. In conclusion, the introduction of thiotepa into a conditioning protocol specifically for AA improves stem cell engraftment without increasing stem cell depletion or damaging non-hematopoietic organs and offers a novel way to combine the strengths of the two "mainstream" existing protocols. The FABT regimen may be an exceptionally effective first-line option for younger SAA patients lacking a matched donor.

HLA matching in contemporary haematopoietic cell transplantation: Recommendations from the EBMT Practice Harmonisation and Guidelines Committee

Highlights:

●      The introduction of post-transplant cyclophosphamide (PTCy) is identified as the most significant "game changer" in the contemporary science of transplant.

●      In the modern clinical practice, a younger matched unrelated donor (MUD) is often preferred over an older matched sibling donor (MSD).

While human leukocyte antigen (HLA) compatibility has traditionally been the "cornerstone" of successful hematopoietic stem cell transplantation (HSCT), the clinical landscape has changed significantly due to several factors. Historically, HLA-mismatched transplants have been consistently associated with inferior survival rates, but recent progress in HLA typing technologies, improved supportive care, and the introduction of novel graft-versus-host disease (GvHD) prophylaxis platforms (specifically PTCy) have prompted a need to revisit how much HLA mismatches matter in modern practice. Clinicians now face the challenge of balancing the risks of HLA mismatching against other influential donor characteristics, such as age, which has been consistently linked to better outcomes across all donor types. Based on the specific methodology published by the EBMT Practice Harmonisation & Guidelines Committee, an international, multidisciplinary group of experts in histocompatibility and immunogenetics, HSCT immunobiology, and clinical HSCT, conducted a consensus-based set of guidelines. The work involved a literature review, drafting of recommendations by leading experts, and a final consensus-based agreement by the entire panel. The main evidence-based recommendations for clinical decision-making (not graded) are summarized below:

1. Modern HLA typing standards:

●      Resolution: Clinical laboratories must use DNA-based, sequence-generating methods to achieve at least high-resolution typing for the patient and all potential donors. Ultra-high resolution is preferred to resolve expression variants like null alleles (see Table 1 in original manuscript).

●      Loci: At a minimum, high-resolution typing should include HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 for the patient and all potential donors.

●      Verification: To rule out disease-related anomalies (like acquired allelic loss), results must be verified with a second sample, ideally from a non-hematopoietic source (such as buccal swab or cultured fibroblasts). Patient and donor HLA typing must be verified with a second sample prior to transplant.

2. Management of anti-HLA antibodies:

●      Mandatory Screening: Screening for donor-specific antibodies (DSA) is mandatory for any patient considered for a haploidentical, mismatched unrelated donor, or umbilical cord blood. Testing should be performed at referral and, if negative, repeated at least one month before conditioning.

●      Clinical Management: DSAs significantly increase the risk of primary graft failure after HSCT across all HLA-mismatched donor sources. Management should be guided by mean fluorescence intensity (MFI) values, and desensitization is required if a donor targeted by DSAs is the only option. DSA levels should be monitored before and after desensitization, at the time of graft infusion, and weekly post-HSCT until DSA clearance of MFI <2000 is achieved.

3. Donor Selection Algorithm:

The experts recommend a stepwise approach (see Figure 1 in the original manuscript):

• Search for an MSD or 10/10 (or 8/8) MUD.

• If multiple MUDs exist, prioritize the youngest donor.

• If no matched donor is available, proceed with the best timely-available alternative (haploidentical, MMUD, or UCB), prioritizing younger age and the absence of DSAs.

4. The Rising Priority of Donor Age:

●      The Age Advantage: Younger donor age is consistently associated with better outcomes (survival and relapse) across all donor types.

●      Shifting Hierarchy: For adult patients with malignancies, a younger MUD may be preferable to an older MSD, particularly when using PTCy or calcineurin inhibitor-based prophylaxis.

5. Impact of Novel GvHD Prophylaxes:

●      PTCy as a “game changer”: The use of PTCy has significantly mitigated the historical risks associated with HLA-mismatched transplants.

●      Permissiveness: While certain models (like the HLA-DPB1 T-cell epitope model) help identify "permissive" mismatches in traditional settings, these associations appear to be negated when using PTCy, suggesting that the "HLA barrier" is much lower in the modern era.

6. Specialized Populations and Monitoring:

●      Non-Malignant/Pediatric Cases: In non-malignant diseases, the goal is durable engraftment with zero graft-versus-host alloreactivity; therefore, the degree of HLA matching remains the primary priority over donor age.

●      HLA-Loss Relapse: Clinicians should test for "HLA-loss" (where malignant cells lose the mismatched HLA allele to escape the immune system) in patients relapsing >6 months after a mismatched transplant. If HLA-loss is detected, the original donor should not be reused for a second transplant.

Late outcomes after posttransplant cyclophosphamide–based GVHD prophylaxis in patients with AML: an ALWP-EBMT study (Retrospective cohort)

Highlights:

 ●      When using a posttransplant cyclophosphamide (PT-Cy)–based graft-versus-host disease (GVHD) prophylaxis, the traditional importance of human leukocyte antigen (HLA) compatibility is attenuated, and clinicians should instead prioritize younger donors and avoid female-to-male sex mismatches to improve long-term survival in patients who receive allogeneic transplant for acute myeloid leukemia (AML).

While PT-Cy has revolutionized haploidentical (Haplo) transplantation and is increasingly used for other donor types, there is a paucity of data regarding long-term outcomes and late posttransplant events in patients with AML who receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) using PT-Cy–based GVHD prophylaxis. The authors evaluate the long-term safety and efficacy of PT-Cy–based HSCT by analyzing a large retrospective cohort of AML patients who remained leukemia-free for at least two years after transplant. All patients were in first complete remission at the time of the transplant. 1,289 patients were included in the final long-term outcome analysis and categorized by donor type as follows: Haplo donors: 906 patients (70%); 10/10 matched unrelated donors (MUD): 208 patients (16%); and matched sibling donors (MSD): 175 patients (14%). Interestingly, the degree of HLA matching did not statistically affect late transplantation outcomes. At 5 years, overall survival (OS) estimates were comparable across groups: 85% for Haplo, 78% for MUD, and 91% for MSD recipients. In the multivariate analysis of the entire patient cohort, sex mismatch (female donor to male recipient), older donor age, and older patient age were independent predictors of long-term transplant outcomes. Sex mismatch was the most significant predictor of adverse late outcomes, being associated with: increased late non-relapse mortality (NRM: hazard ratio [HR], 2.70; p=0.013); decreased leukemia free-survival (HR, 1.82; p=0.018); and decreased OS (HR, 2.10; p=0.014). Also, each 10-year increase in donor age was significantly associated with an increased risk of late NRM (HR, 1.34; p=0.036), and older patient age was associated with decreased OS (HR per 10-year increase, HR, 1.28; p=0.043). Within the Haplo cohort, the associations for older donor age (HR, 1.48; p=0.026) and female-to-male sex mismatch (HR, 3.03; p=0.018) remained statistically significant. The limited number of events precluded separate analysis of their impact in the MUD and MSD cohorts.

In conclusion, the degree of HLA matching does not appear to affect long-term outcomes in the setting of allo-HSCT using PT-Cy in patients with AML. PT-Cy–based transplantation provides a safe and effective long-term platform for AML, reinforcing the growing role of Haplo donors and the need to refine donor selection based on factors beyond just HLA compatibility.

Impact of busulfan- versus treosulfan-based conditioning on the incidence of sinusoidal obstruction syndrome/venoocclusive disease after allogeneic hematopoietic cell transplantation: a dual-center real-world study (Correspondence)

Highlights:

●      Busulfan-based conditioning is consistently associated with a markedly higher risk of developing sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD). Treosulfan exhibited a favorable safety profile even in patients with pre-existing risk factors, supporting its use as a reduced-toxicity alternative.

SOS/VOD is a potentially severe and life-threatening complication for patients undergoing allogeneic hematopoietic cell transplantation (allo-HSCT). Despite the lack of extensive comparative data, recent medical consensus has classified the alkylating agents busulfan and its hydrophilic analogue, treosulfan as risk factors for SOS/VOD. While busulfan is a well-established modifiable risk factor for SOS/VOD, historically, there has been limited data regarding the risk associated with treosulfan. A large, dual-center, real-world, observational retrospective study analyzed data from 927 consecutive adult patients (450 in the treosulfan group and 477 in the busulfan group) who received an allo-HSCT between January 2017 and December 2023. In univariate analysis, the cumulative incidence of SOS/VOD was significantly lower in patients treated with treosulfan (1.6%) compared to those treated with busulfan (6.9%) (p<0.001). Multivariable analysis confirmed this observation and busulfan-based conditioning was associated with a 4.47-fold increased risk of developing SOS/VOD (hazard ratio: 4.47, p<0.001). Among patients who developed the complication, those in the treosulfan group had a significantly longer median time to diagnosis (56 days) compared to those in the busulfan group (21 days) (p=0.001). Despite the treosulfan group having a higher prevalence of established risk factors at baseline (including more intensive conditioning, a higher frequency of second transplants, and more mismatched donors), the incidence of SOS/VOD remained significantly lower than in the busulfan group. In conclusion, this study provides evidence to suggest that treosulfan is a reduced-toxicity alternative to busulfan, particularly for patients with pre-existing risk factors for SOS/VOD.

Randomized, Placebo-Controlled Trial of B-Cell Depletion for Prevention of Corticosteroid-Requiring Chronic Graft-Versus-Host Disease (Clinical Trial)

Highlights:

●       The prophylactic administration of the B-cell-depleting antibody obinutuzumab significantly reduced the one-year incidence of corticosteroid-requiring chronic graft-versus-host disease (cGVHD). This finding identifies a potent new prevention strategy for patients undergoing stem cell transplantation who are at higher risk for this condition.

Traditional methods to prevent cGVHD often lead to significant complications. These include impaired engraftment, long-lasting immune defects, and an increased risk of malignant relapse. There is a specific clinical need for prevention strategies that can be delivered after successful stem cell engraftment without causing permanent damage to the patient's immunity. An interesting point of view is the recognition of  the pathogenic role of B-cells in the pathophysiology of GVHD. A recent prospective, multicenter, randomized, and blinded clinical trial evaluated whether prophylactic B-cell depletion using the antibody obinutuzumab can successfully prevent the development of corticosteroid-requiring cGVHD in high-risk patients following allogeneic stem cell transplantation (allo-HSCT). The primary objective was the incidence of corticosteroid-requiring cGVHD 12 months after allo-HSCT. Participants had to have received tacrolimus-based GVHD prevention. Those who received peri-transplant T-cell depletion (in vivo or ex vivo) or post-transplantation cyclophosphamide-based prophylaxis were ineligible. 178 participants (out of 181 randomized) who were considered at higher risk for developing cGVHD were assigned to receive either obinutuzumab (n=90) or placebo (n=88). The authors observed a significant reduction in cGVHD. The 1-year incidence of corticosteroid-requiring cGVHD was significantly lower in the obinutuzumab group (13.3%) compared to the placebo group (35.2%; p=0.0005). Also, there was a significant improvement in immunosuppression-free, relapse-free survival at two years for the obinutuzumab arm (48%) versus the placebo arm (34%; p=0.02). The most significant reduction in steroid-requiring cGVHD was seen in patients without preformed H-Y (Y chromosome-encoded minor histocompatibility) antibodies at the time of study entry. In this subgroup, the incidence was only 8.6%, which was significantly lower than all other participants combined (42%; p=0.001). Grade 3-4 neutropenia was significantly more common in the obinutuzumab group (n=34, 37.5%) than in the placebo group (n=4, 4.6%; p<0.0001). There was no difference in the rates of mild or severe thrombocytopenia between study groups (3.3% v 2.3%; p=0.16).

The authors conclude that prophylactic B-cell depletion is a highly effective strategy for patients at higher risk of cGVHD. Based on the H-Y antibody data, they suggest that earlier intervention (before B-cell responses to host antigens are established) should be considered for future clinical trials to further optimize prevention.

Efficacy and safety of ruxolitinib for graft-versus-host disease prophylaxis in patients with aplastic anemia undergoing PBSC-only allogeneic stem cell transplantation: a prospective phase II study 

Highlights:

●      Peri-transplant ruxolitinib added to standard graft-versus-host disease (GVHD) prophylaxis in peripheral blood (PB) allogeneic hematopoietic cell transplant (allo-HSCT) for aplastic anemia (AA) reduced grade II–IV acute GVHD (aGVHD) from 38.9% to 13.0% (hazard ratio [HR] 0.24; p=0.004) and severe (grade III–IV) aGVHD (0% vs. 15.8%; p=0.008).

●      The addition of ruxolitinib was associated with significantly superior 1-year GVHD-free, failure-free survival (91.6% vs. 72.1%; HR 0.23; p=0.012) when compared to a historical control arm.

This prospective, open-label, single-arm phase II trial (NCT05914714) enrolled 46 AA patients (out of 58 screened) at a single Chinese center between June 2023 and December 2024, compared with 36 historical controls (out of 97 screened) using inverse probability of treatment weighting to address baseline imbalances. All patients received PB with fludarabine, cyclophosphamide and antithymocyte globulin with or without busulfan conditioning and standard GVHD prophylaxis plus ruxolitinib 5 mg twice daily starting with conditioning and through day +90.

Ruxolitinib was associated with superior platelet engraftment at day +28 (84% vs. 53%; weighted p=0.03), and secondary poor graft function was significantly reduced (10.9% vs. 33.3%). One-year overall survival was 92.1% vs. 85.8% (weighted p=0.318). Subgroup analyses showed the greatest benefit was in haploidentical allo-HSCT recipients (hazard ratio [HR] 0.15; weighted log-rank p=0.001) and those with documented pretransplant infection (HR 0.23; weighted log-rank p=0.028). A notable safety signal was the higher rate of Epstein-Barr virus (EBV) reactivation in the ruxolitinib group (34.8% vs. 8.8%; p=0.010), including three fatal cases of EBV-hemophagocytic lymphohistiocytosis.

The authors conclude that these results establish ruxolitinib as a promising GVHD prophylaxis. By reducing grade II-IV aGVHD while preserving engraftment, ruxolitinib helps overcome a major limitation of PB grafts. Confirmation is warranted in larger, multicenter trials.

Updated results from inMMyCAR, the ongoing first-in-human phase 1 study of KLN-1010 in patients (pts) with relapsed and refractory multiple myeloma (RRMM) (Phase I clinical trial)

Highlights:

●      KLN-1010 — an in vivo anti-BCMA chimeric antigen receptor (CAR) T-cell therapy delivered as a single infusion of a modified lentiviral vector, requiring no apheresis, lymphodepletion, or ex vivo manufacturing — achieved a 100% overall response rate and minimal residual disease (MRD)-negative bone marrow at one month in all evaluable patients with relapsed/refractory multiple myeloma (RRMM), across 18 doses.

inMMyCAR (NCT07075185) is a phase 1, open-label, dose-escalation trial evaluating a single dose of KLN-1010 in up to 40 patients with RRMM across three dose levels. KLN-1010 encodes a human anti-BCMA CAR delivered via a modified lentiviral vector infused directly into patients with no need of lymphodepletion. Fourteen additional patients have been enrolled since the American Society of Hematology 2025 presentation of the inMMyCAR study, (the first-in-human phase I trial), bringing the total to 18 patients dosed. All evaluable patients achieved MRD negativity in bone marrow at one month post-infusion. Detailed response depth, durability data by dose level, and full toxicity breakdowns were not available from the conference abstract; full peer-reviewed publication is pending.

The authors conclude that this data support early clinical activity and safety comparable to other BCMA CAR T-cell in MM, including persistent MRD-negativity in the patient with longest follow-up (6 months) with a stringent complete response. Activity was also observed in the patient with extramedullary disease, with complete resolution by month 1.

Incidence of and Risk Factors for Delayed Engraftment after Post-Transplant Cyclophosphamide (Retrospective Single-Center Cohort Study)

Highlights:

●      Delayed engraftment occurred in 16% of patients receiving post-transplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis, and was independently associated with age ≥65 years (odds ratio [OR] 7.52; p<0.0001), while male sex, and myeloproliferative neoplasm (MPN) or myelodysplastic syndrome (MDS) diagnosis were also associated with delayed engraftment but these increased ORs were not statistically significant (OR 2.49; p=0.07 and OR 2.53; p=0.07, respectively).

●      PTCy-attributed organ toxicity — particularly stage 3 acute kidney injury (AKI: OR 10.79; p=0.0019) and cardiotoxicity (OR 2.83; p=0.053) — was strongly associated with increased odds of delayed engraftment, suggesting a role for impaired cyclophosphamide clearance.

This single-center retrospective cohort study analyzed 170 patients receiving PTCy (50 mg/kg/day on day+3 and day+4) paired with tacrolimus/mycophenolate. Diagnoses included acute myeloid leukemia (38%) and MDS (12%); 49% received haploidentical grafts and 30% mismatched unrelated donor grafts; 83% received reduced-intensity or non-myeloablative conditioning. Of 165 patients, after excluding 5 with primary graft failure, 26 (16%) met criteria for delayed engraftment. Median time to neutrophil engraftment was 16 days (range 12–29) and platelet engraftment 24 days (range 10–201). Median length of stay was 36 days in the delayed engraftment group vs. 26 days in all others. Clinically significant early organ toxicity occurred in 18% of patients, with cardiotoxicity (14%) and stage 3 AKI (5%) being most frequent. Any-organ toxicity was associated with delayed engraftment (OR 4.63; p=0.0014). Overall GVHD outcomes were favorable: grade II–IV acute GVHD 19%, grade III–IV 7%, and chronic GVHD 21% at one year. Non-relapse mortality was 10% at one year; overall survival was 82% at one year and 77% at two years.

The authors conclude that PTCy-based GVHD prophylaxis is not a "one size fits all" regimen and that older patients and those with MPN/MDS warrant particular attention regarding engraftment kinetics and organ toxicity monitoring related to PTCy.

CSF-1R inhibition and lenalidomide synergize to promote myeloma control after autologous stem cell transplantation (Translational Brief Report)

Highlights:

●      CSF-1R⁺CD163⁺CD169⁺ immunosuppressive macrophages are expanded in the bone marrow (BM) at relapse after autologous hematopoietic cell transplant (ASCT). CSF-1R⁺ macrophages suppress lenalidomide-induced NK-like CD8⁺ T cells and phenotypically exhausted (Tphex) CD8⁺ T-cells via CD94/NKG2A and PD-L1/PD-1; CSF-1R blockade reverses this suppression and synergizes with lenalidomide to attenuate myeloma progression in preclinical models.

Using serial BM samples from myeloma patients, this study identified a CD64⁺CD169⁺CD163⁺ macrophage subset expressing CSF-1R, PD-L1, and CD155 that was selectively expanded at relapse and correlated with myeloma burden at post-ASCT timepoints (r²=0.477; p=0.01), but not pre-ASCT (r²=0.012; p=0.78). In a Vk*MYC preclinical ASCT model with suboptimal endogenous antimyeloma immunity, monotherapy with either αCSF-1R or lenalidomide did not significantly reduce progression, whereas their combination synergistically decreased progression (p<0.05) and prolonged survival (p<0.01).

Single cell RNA sequencing on sorted myeloid and T cells from the BM across all four treatment groups revealed that lenalidomide was the primary driver of CD8⁺ T-cell phenotype — expanding NK-like CD8⁺ T cells with decreased inhibitory receptor expression — while paradoxically also expanding CSF1R⁺ macrophages. Cell-cell communication analyses identified these macrophages as the dominant source of PD-L1/PD-1 signaling to Tphex and CD94/NKG2A-mediated suppression of NK-like CD8⁺ T cells. CSF-1R blockade depleted these immunosuppressive macrophages, decreasing expression of inhibitory receptors (Pdcd1, Cd244a, Lag3) and increasing expression of activation markers (Ly6a, Xcl1, Ly6c2) in Tphex.

Given the FDA approval of axatilimab for chronic graft-versus-host disease and the established role of lenalidomide maintenance after ASCT, the authors propose that combining CSF-1R blockade with lenalidomide maintenance is a clinically actionable and readily testable strategy to improve progression-free survival in myeloma.

Comparative Evaluation of Single-Dose and Split-Dose Melphalan Conditioning Concerning Toxicity Profiles and Engraftment Kinetics: A Propensity Score-Matched Analysis (Retrospective study)

Highlights:

●      In patients undergoing autologous hematopoietic cell transplant, single-dose melphalan (200 mg/m²) was associated with produced significantly lower incidence of severe gastrointestinal toxicity (grade ≥ 3 mucositis and/or diarrhea) than split-dose (100 mg/m² × 2 days) conditioning (19.8% vs. 36.6%; odds ratio [OR] 0.43; p=0.012), along with reduced renal (OR 0.31; p=0.007) and hepatic toxicity (OR 0.39; p=0.033).

●      No differences in Day +90 response, progression-free survival (PFS), or overall survival (OS) were observed between the two dose schedules.

This study analyzed 202 propensity score-matched patients with multiple myeloma across three tertiary centers (2016–2026), with 101 patients per group. Matching was performed using age, sex, performance status, International Staging System stage, and renal function (eGFR <40 vs. ≥40 mL/min/1.73 m²). While any-grade oral mucositis was more frequent in the single-dose group (81.2% vs. 57.4%; p <0.001), these events were predominantly low-grade and did not translate into higher rates of grade ≥3 mucositis (5.9% vs. 7.9%; OR 0.73; p =0.783). Unadjusted analysis showed faster neutrophil (11 vs. 12 days; p<0.001) and platelet (11 vs. 13 days; p <0.001) engraftment in the split-dose group, but multivariable models identified the 48-hour melphalan-to-infusion interval — used in 57 of 101 split-dose patients — as the sole independent driver (neutrophil: p=0.0008; platelet: p<0.001).

No engraftment difference was observed between single-dose and the split 24-hour subgroup. Day +90 overall response rate was 94.1% vs. 93.8% (p=1.00), with comparable complete response rates (71.3% vs. 64.4%). With a median follow-up of 36.5 months, median PFS was 33.6 vs. 34.7 months (p=0.552) and 3-year OS was 80.0% vs. 83.1% (p=0.598).

The authors conclude that single-dose melphalan is the safer strategy and that clinicians can optimize engraftment by extending the stem cell infusion interval to 48 hours without the need for dose fractionation.

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