Given the high risk of toxicity with DNA-damaging agents in FA and the high sensitivity of myeloblasts with the FA DDR defect, FA-related MDS/AML is typically treated with RIC HSCT without intensive chemotherapy before conditioning.21-25 However, in view of the blasts being of donor origin (ie, no chemotherapy-sensitizing FA DDR defect) and the planned use of RIC for a second HSCT, she was considered to be at high risk for post-transplant relapse without remission-inducing antileukemia therapy before conditioning. The gene discussed is FANCA; the disease is myelodysplastic syndrome.