Cancer in Fanconi anemia.

of CMV reactivation were reported by other groups using fludarabine in combination with busulphan, melphalan, or low-dose total body irradiation (TBI) (21%-42%). 5,6 The median time of onset of CMV infection was also beyond 45 days in all these studies. The only other regimen associated with a higher and earlier incidence of CMV infection has been a combination of fludarabine and antilymphocyte globulin. 7 Thus, fludarabine used alone, without other antilymphocyte antibodies, does not seem to increase the predisposition to earlier or higher CMV infections. Whether Campath used alone rather than in combination with fludarabine would be associated with a lower incidence of CMV infection remains speculative and is not supported by the existent literature. I would also like to make a few comments regarding the data presented by Bainton et al. 1 Firstly, the patients receiving BEAM (BCNU, etoposide, cytosine arabinoside, melphalan)–Campath (those not receiving fludarabine) received transplants only for lymphoma/chronic lymphocytic leukemia (CLL) and mostly received matched related grafts (14 of 18). On the other hand, those receiving fludarabine, either as a part of the protocol described by us 2 or in addition to BEAM-Campath, were mostly recipients of unrelated donor grafts (11 of 18) and received transplants mostly for diseases other than lymphoma/CLL (11 of 18). Although the authors mention that there was no difference between related and unrelated donors (UDs), this comparison would be restricted entirely to the fludarabine group, as there were no transplants from unrelated donors in the other group. Thus, to attribute the increased CMV reactivation to fludarabine alone might not be entirely acceptable given the above differences. Given the small sample size and the heterogeneity, the power of a multivariate analysis taking the donor type or underlying diagnosis into account might not be satisfactory either. Secondly, Bainton et al stated that there was no difference in the incidence of CMV reactivation between patients receiving Campath-1H (alemtuzumab) (15 of 16) and Campath-1G (13 of 20). In fact, the P value by Fisher exact test (2-tailed) turns out to be .05. Although the conventional cutoff for significance is .05, it might not be entirely acceptable to ignore a P value of .05 and formulate the inferences on a P value of .04 (the Fisher exact P value for CMV reactivation with and without fludarabine), given the small number of patients. Hence, the statistical interpretation indicates a suggestive trend toward significantly more CMV reactivation in …