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August 18, 2004

Preimplantation Testing to Produce an HLA-Matched Donor Infant

Author Affiliations

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

JAMA. 2004;292(7):803. doi:10.1001/jama.292.7.803-a

To the Editor: Dr Verlinsky and colleagues1 described their experience in preimplantation HLA testing in order to conceive infants who would be possible HLA matches for stem cell donations for siblings with acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), or Diamond-Blackfan anemia (DBA). We disagree that childhood acute leukemias necessarily require bone marrow transplantation, however, as chemotherapy alone is associated with an 80% 5-year cure rate in children with ALL2 and with a 60% cure rate for children with AML.3 Thus, stem cell transplantation for children within a first remission is generally considered only for those at high risk, as results for transplantation are inferior to those for chemotherapy alone.4 Bone marrow transplantation for those with a second remission has a 5-year event-free survival rate of 40%-50%.4