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This personalized targeted preparative regimen is a multi-drug conditioning protocol developed by the Dmitriy Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology for pediatric patients with chemoresistant or chemorefractory acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). The regimen integrates three targeted agents—venetoclax (a BCL-2 inhibitor), daratumumab (an anti-CD38 monoclonal antibody), and plerixafor (a CXCR4 antagonist)—with a high-dose chemotherapy backbone consisting of fludarabine, cytarabine, treosulfan, and thiophosphamide. This combination is designed to sensitize leukemia cells and reduce disease burden prior to αβ T-cell-depleted peripheral blood stem cell transplantation, typically from haploidentical donors. The selection and administration of the targeted agents are personalized based on the measured expression of BCL-2, CD38, and CXCR4 on the patient's leukemic blasts to optimize efficacy in refractory cases.
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