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We appreciate the issues Drs Kulkarni and Arya raise, in particular the potential implications of our study outside of the United States. As we stated in our publication, our findings “may only be generalized to institutions with a similar degree of standardization of care for nonparticipants in clinical trials.” If inclusion of patients in clinical trials in developing countries is a primary way to facilitate treatment completion, the patient population is clearly distinct from the population in our study.
Koschmann C, Thomson B, Hawkins DS. Trial Effect in Newly Diagnosed Pediatric Acute Lymphoblastic Leukemia—Reply. Arch Pediatr Adolesc Med. 2010;164(9):882-883. doi:10.1001/archpediatrics.2010.142