To the Editor: Dr Couri and colleagues1 provided a follow-up study of patients with newly diagnosed type 1 diabetes mellitus treated with autologous nonmyeloablative hematopoietic stem cell transplantation. The authors noted that 160 patients were screened, but only 23 were enrolled. To further evaluate the possible generalizability of these findings, it would be helpful to know why screened patients were not eligible and why eligible patients elected not to participate.
From the safety perspective, we also wondered whether any infectious issues aside from pneumonia were noted. In particular, we would like to know if primary infection of cytomegalovirus or Epstein-Barr virus or reactivation occurred. Epstein-Barr virus reactivation was noted in a trial of treating new onset type 1 diabetes with an anti-CD3 monoclonal antibody (ChAglyCD3).2
While the authors' protocol demonstrated substantial efficacy, it is not clear whether such an aggressive approach is necessary. Perhaps treatment with anti-thymocyte globulin or granulocyte colony stimulating factor, as monotherapy or in combination, would provide comparable efficacy with a more favorable adverse effect profile. Investigator-initiated trials of treating new onset type 1 diabetes with anti-thymocyte globulin alone3 and granulocyte colony stimulating factor alone4 are now under way.
Financial Disclosures: Dr Gitelman reported serving on an advisory board for Genzyme Corporation, Cambridge, Massachusetts, manufacturer of Thymoglobulin (anti-thymocyte globulin). No other disclosures were reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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