alemtuzumab + fludarabine + melphalan (Medical College of Wisconsin)

This reduced-intensity conditioning (RIC) regimen, known as the RICHI protocol, consists of a combination of alemtuzumab, fludarabine, and melphalan. It was specifically developed for use in allogeneic hematopoietic stem cell transplantation (HCT) for patients with hemophagocytic syndromes and primary immunodeficiencies. The regimen utilizes intermediate-timing alemtuzumab (administered on days -14 through -10) to facilitate donor engraftment and reduce the risk of graft-versus-host disease (GVHD) while minimizing the high treatment-related mortality associated with traditional myeloablative conditioning. Fludarabine is administered on days -8 through -4, followed by melphalan on day -3. This approach is designed to achieve stable mixed or full donor chimerism, which is curative for disorders such as hemophagocytic lymphohistiocytosis (HLH), chronic granulomatous disease (CGD), and other primary immune defects.

Other names

Intermediate-timing alemtuzumab RIC regimenRICHI protocol