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Autologous stem cell transplants in Jehovah's Witnesses

Bone Marrow Transplantation volume 44, pages 391–392 (2009)Cite this article

High-dose chemotherapy (HDC) followed by an autologous peripheral blood stem cell transplant (ASCT) provides the best option for long-term survival for patients with relapsed or high-risk lymphoma and prolongs survival in patients with multiple myeloma (MM).1, 2 HDC causes severe anemia and thrombocytopenia, routinely treated with platelet and RBC transfusions. Because for religious reasons Jehovah's Witnesses (JWs) refuse blood transfusions, which they define as RBCs, platelets and plasma, treating these patients has been a unique challenge for physicians. We present an overview of 70 JWs treated with our transfusion-free ASCT protocol, followed by a case study of a JW with MM who received a second transplant upon progression of disease; this procedure had never been performed on a JW due to expected profound pancytopenia.

The Center for Bloodless Medicine and Surgery at Pennsylvania Hospital has treated 70 patients with HDC and ASCT without the use of blood transfusions for lymphoma (39), MM (29) and breast cancer (2). Although JW do not accept blood transfusions, the decision to accept blood fractions is up to the individual congregant. Most JW will accept PBSCs, albumin, cryoprecipitate, clotting factors and other proteins found in blood. To avoid fresh frozen plasma during cryopreservation, we cryopreserved the patients' stem cells in albumin and normal saline. For our 70 patients, the average age was 47 years (with a range of 21–70 years) and 42 of 70 patients (60%) had over 4.0 × 106 CD34+ cells per kg reinfused, with an average of 6.0 × 106 CD34+ cells per kg reinfused (range 0.52–24.6 × 106 CD34+ cells per kg). Only 14 of 70 (20%) of our patients with lymphoma and MM received a transplant as first-line therapy. Ninety-five percent of our patients with lymphoma had multiple salvage chemotherapy treatments, which may contribute to a poorer graft quality and more significant pancytopenia.

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References

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Authors and Affiliations

  1. Drexel University College of Medicine,, Philadelphia, PA, USA

    N M Brown

  2. Princeton University,, Princeton, NJ, USA

    S Y Kim

  3. Peripheral Stem Cell Transplant Program, Center for Bloodless Medicine and Surgery, Pennsylvania Hospital, Philadelphia, PA, USA

    P A Ford

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  1. N M Brown
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  2. S Y Kim
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  3. P A Ford
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Correspondence to P A Ford.

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Brown, N., Kim, S. & Ford, P. Autologous stem cell transplants in Jehovah's Witnesses. Bone Marrow Transplant 44, 391–392 (2009). https://doi.org/10.1038/bmt.2009.43

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