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High-dose chemotherapy and autologous peripheral blood stem cell transplantation in lymphoma without blood product support

Bone Marrow Transplantation volume 26, page 1140 (2000)Cite this article

The recent paper by Ballen et al1 adds to the literature2 on autologous stem cell transplantation in patients unwilling to receive either donated or pre-deposited autologous blood products. As pointed out by the author, the safety of autologous transplantation in such a group remains uncertain due to the paucity of reports in the literature. We would like to report a case of a relatively complicated autologous PBSC transplant in a Jehovah's Witness. The patient, a 47-year-old male, was diagnosed with follicular lymphoma in 1998 having presented with widespread para-aortic lymphadenopathy and a right-sided hydronephrosis. Despite initial treatment with radiotherapy and CHOP chemotherapy, he relapsed 1 year later and was unresponsive to pulsed chlorambucil therapy.

Following a course of anti-CD20 (Mabthera, Roche, UK) therapy, to which a partial response was obtained, he was referred for consideration of high-dose chemotherapy. The patient was counselled and the increased risks of the procedure, particularly haemorrhagic complications arising from the patients’ decision not to receive blood product support, were explained. The case was discussed with the Hospital Risk Management Committee who advised that the patient should be specifically advised of the risk of non-fatal cerebral haemorrhage with permanent neurological sequelae and disability.

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References

  1. Ballen K, Ford P, Waitkus H et al. Successful autologous bone marrow transplant without use of blood support Bone Marrow Transplant 2000 26: 227–230

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  2. Estrin JT, Ford PA, Henry D et al. Erythropoietin permits high-dose chemotherapy with peripheral blood stem cell transplant for a Jehovah's Witness Am J Hematol 1997 55: 51–52

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  3. McQuaker IG, Haynes AP, Stainer C et al. Mobilisation of peripheral blood stem cells with IVE and G-CSF improves CD34+ cell yields and engraftment following high-dose chemotherapy in patients with non-Hodgkin's lymphoma and Hodgkin's disease Bone Marrow Transplant 1999 24: 715–722

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  1. Department of Haematology, Nottingham City Hospital NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK

    A Sefcick, JL Byrne & NH Russell

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  1. A Sefcick
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  2. JL Byrne
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  3. NH Russell
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Sefcick, A., Byrne, J. & Russell, N. High-dose chemotherapy and autologous peripheral blood stem cell transplantation in lymphoma without blood product support. Bone Marrow Transplant 26, 1140 (2000). https://doi.org/10.1038/sj.bmt.1702683

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