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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 . . . [Full Text of this Article]

Stephen E. Gitelman, MD
sgitelma@peds.ucsf.edu
University of California, San Francisco

Michael J. Haller, MD; Desmond Schatz, MD
University of Florida
Gainesville

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C-Peptide Levels and Insulin Independence Following Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus
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