What is considered definitive management for major alpha-thalassemia?

• A. Iron chelation therapy
• B. Regular phlebotomy
• C. Splenectomy
• D. Allogeneic bone marrow transplant

Answer: (D)

Definitive management for major alpha-thalassemia is allogeneic hematopoietic stem cell transplantation, which replaces the patient's defective erythropoiesis with healthy donor stem cells and can cure the disease. In severe alpha-thalassemia, the body cannot produce adequate functional alpha-globin, leading to lifelong transfusion dependence and iron overload. While iron chelation helps manage iron burden and splenectomy or other supportive measures may reduce transfusion needs in some cases, they do not address the underlying genetic problem or provide a lasting cure. A matched donor transplant offers the potential for a durable cure by establishing a new, healthy hematopoietic system that produces normal hemoglobin. However, it carries risks such as graft-versus-host disease and infection, so eligibility and timing are carefully considered.