Combination Therapy With Danazol, Prednisolone, and Thalidomide for Thalidomide-Refractory Transfusion-Dependent β-Thalassemia

Inclusion Criteria: * Age 5 to 15 years with confirmed transfusion-dependent beta-thalassemia major. * Documented non-response to adequately dosed thalidomide therapy for at least 6 months. * Pre-transfusion hemoglobin less than 9.0 g/dL with continued transfusion dependence (more than 2 units per month). * Adequate baseline clinical and laboratory assessment for safe study treatment. * Stable transfusion and iron-chelation regimen according to the protocol. * Written informed consent from parent/legal guardian and age-appropriate assent from the participant, with willingness to comply with study procedures and follow-up. Exclusion Criteria: * Previous allogeneic hematopoietic stem cell or bone marrow transplantation. * Diabetes mellitus or clinically significant uncontrolled metabolic disease. * Active severe infection or uncontrolled hepatic, renal, or cardiovascular disease. * Significant pre-existing peripheral neuropathy or history of clinically significant thromboembolic disease. * Known hypersensitivity to any study medication.