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August 18, 2004

Preimplantation Testing to Produce an HLA-Matched Donor Infant—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(7):803. doi:10.1001/jama.292.7.804-a

In Reply: Drs Fasth and Wahlstrom point out that stem cell therapy may not be an option for ALL or AML, given the effectiveness of chemotherapy. However, given the sizeable proportion of treatment failures that Fasth and Wahlstrom note, we believe that the option of stem cell therapy should still be available for patients for whom chemotherapy is not effective, particularly if the parents plan to have another child anyway. ALL and AML are still in the list of conditions for which cord blood transplantation has been performed for many years. We agree with Dr Wagner and colleagues that preimplantation HLA typing for inherited forms of DBA should be combined with preimplantation genetic diagnosis (PGD) of DBA. However, as we mentioned in our article, all known mutations causing DBA were excluded in our cases by detailed mutation testing in parents and affected children, and this was also confirmed by the ongoing follow up studies of the HLA-matched children born after preimplantation HLA typing.

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