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To the Editor: Both Dr Verlinsky and colleagues¹ and Dr Fost² argue that in vitro fertilization (IVF) with preimplantation HLA matching poses no risk of creating a donor child with either DBA or acute leukemia. However, the procedure may inadvertently transfer unidentified DBA genes, as cases of DBA have now been identified in which the disorder is inherited from a parent with a "silent phenotype" in whom there are no hematologic or nonhematologic manifestations.^3-5 These instances underscore the unpredictability of the disease and the possibility that what may appear to be sporadic mutations are actually inherited. This is further complicated in that later prenatal testing is not possible in those cases for which the responsible mutation remains unidentified. Therefore, preimplantation HLA testing to create a donor may inadvertently result in a child affected by the disorder. Indeed, neither article clarifies whether any of these 9 cases had been rejected by . . . [Full Text of this Article]

John E. Wagner, MD
Blood and Marrow Transplantation Program and Stem Cell Institute
School of Medicine

Jeffrey P. Kahn, PhD, MPH
kahnx009@umn.edu
Center for Bioethics

Susan M. Wolf, JD
School of Law
University of Minnesota
Minneapolis

Jeffrey M. Lipton, MD, PhD
Division of Pediatric Hematology/Oncology and Stem Cell Transplantation
Schneider Children's Hospital
Albert Einstein College of Medicine
New Hyde Park, NY

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