AUTHOR=Li Xuewei , Zhang Wenhui , Li Saisai , Ma Xiaolin , Shi Xue , Wang Wei , Sun Lingjie , Qiu Kuan , Zhao Yanxia , Zhao Chunting , Liu Xiaodan TITLE=Successful third haploidentical hematopoietic stem cell transplantation after two graft failures in a pediatric patient with severe aplastic anemia: a case report with five-year follow-up JOURNAL=Frontiers in Immunology VOLUME=Volume 16 - 2025 YEAR=2025 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2025.1607926 DOI=10.3389/fimmu.2025.1607926 ISSN=1664-3224 ABSTRACT=BackgroundHematopoietic stem cell transplantation (HSCT) offers a potentially curative option for severe aplastic anemia (SAA). However, graft failure (GF) remains a life-threatening complication following HSCT. Haploidentical HSCT may serve as an effective salvage therapy for the treatment of GF.Case presentationThis report describes a 3-year-old girl with acquired SAA who experienced GF twice following matched unrelated donor (MUD) transplantations. Successful engraftment was ultimately achieved through a third haploidentical donor HSCT. This work was conducted in accordance with the Declaration of Helsinki and the Declaration of Istanbul.ConclusionsBased on our experience with this case, we conclude that a third HSCT with a haploidentical donor represents a viable approach to extending survival.