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Autologous and allogeneic stem cell transplant in Jehovah’s Witnesses: a single-center experience on 22 patients

Bone Marrow Transplantation volume 51, pages 1002–1003 (2016)Cite this article

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Jehovah’s Witnesses (JW) are a growing population, now numbering 20 million in the world, and 450 000 in Italy. Owing to their refusal to undergo blood transfusions, there is an increasing need for alternative models to cure high-risk onco-hematologic malignancies, in which transfusion support is generally the rule within a chemotherapeutic or transplantation strategy. The literature shows few extensive papers and case reports on this topic.1, 2, 3, 4, 5 We also previously reported eight cases of autologous and allogeneic hematopoietic stem cell transplants (SCT) performed for heterogeneous diseases,6 demonstrating its feasibility. The possibility to use less intensified conditioning chemotherapy (for example, for elderly people) and to manage differently the aplastic phase after SCT is of extreme interest for the Authors and a matter of scientific challenge.7 Here we report our experience of almost 20 years on autologous and allogeneic BMT offered to JW, with the aim to extrapolate a model of assistance.

As the reference Center for the South-East of Italy for JW, with overall 234 consultations since 1994, we have treated 75 patients for onco-hematological diseases. Twenty-two patients (15 males, 7 females; mean age 49 years, range 14–71 years; 86% under 60 years) have undergone SCT during the course of the disease, for a total of 24 procedures, and have been retrospectively included in the study. Patients gave written informed consent for the collection of clinical data, in accordance with the Declaration of Helsinki. Thirteen procedures were autologous and 11 allogeneic SCT. Seven patients had multiple myeloma (MM), three acute myeloid leukemia (AML), three follicular non-Hodgkin lymphomas (FL) grade 3, one classic Hodgkin’s lymphoma (HL), one acute lymphoblastic leukemia (ALL), one lymphoblastic lymphoma (LBL), one primary myelofibrosis (MF), three chronic myeloid leukemia (CML), one in blastic phase, one Waldenstrom macroglobulinemia (WM) and one metastatic breast cancer (mBC). The SCT procedure was done as part of first-line therapy in six patients (two MM, two CML, two AML), second-line in nine patients (two NHL, two MM, one LBL, one MF, one CML in blastic phase, one ALL and one AML), third-line or more in seven patients (three MM, one NHL, one HL, one WM and one mBC). Two patients with MM received both autologous and allogeneic SCT. Conditioning regimens for autologous SCT were BEAM (carmustine, etoposide, aracytin and melphalan) for lymphomas and melphalan 200 mg/m2 (140 mg/m2 for patients older than 60 years) for MM.8, 9 A myeloablative regimen was applied in the allogeneic setting for 6 patients: cyclophosphamide 120 mg/kg and TBI 12 Gy fractionate in LBL/ALL; busulphan 14 mg/kg plus cyclophosphamide 120 mg/kg in AML and CML. In order to shorten the duration of therapy, without reducing the intensity, we made an overlap instead of sequential administration of drugs such as cyclophosphamide overlapping busulfan or thiotepa. MM and MF patients received reduced intensity conditioning (RIC) that consisted of thiotepa 10 mg/kg, cyclophosphamide 30 mg/kg and fludarabine 30 mg/m2 for 2 days. We reinfused a minimum of 3 × 106/kg for autologous and 5 × 106/kg CD34+ hematopoietic stem cells (HSCs) for allogeneic SCT. The preferred source of HSCs was peripheral blood (11 autologous, 5 allogeneic SCT); bone marrow HSC were used in 1 autologous and 2 allogeneic SCT; we collected HCS from both sources when we predicted a delayed hematologic recovery or expected a drop of hemoglobin level putting life at risk; both peripheral and bone marrow HSC were used in one autologous and four allogeneic SCT. The donors for allogeneic SCT were siblings for nine patients and matched unrelated for two patients (Table 1). Patients received epoetin alfa 1500 IU/kg three times a week, starting 3 days following the reinfusion of HSC up to hemoglobin >10 g/dL (median of 22 and 18 days of treatment for allogeneic and autologous SCT, respectively). The use of lenograstim (5 mcg/Kg/day) was limited to patients without recovery of PMN after 2 weeks from SCT. Patients were monitored by blood tests every 3 days in order to avoid excess blood consumption; daily monitoring of life parameters were ensured together with cardiac check in case of severe anemia.

Table 1 Source of HSC, conditioning regimens and engraftment
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Acknowledgements

We thank Caroline Oakley for linguistic revision of the manuscript.

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  1. Department of Oncology, Hematology Unit and BMT, San Giuseppe Moscati Hospital, Taranto, Italy

    P Mazza, G Palazzo, C Minoia, B Amurri & G Pisapia

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  1. P Mazza
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  2. G Palazzo
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  3. C Minoia
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Correspondence to C Minoia.

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Mazza, P., Palazzo, G., Minoia, C. et al. Autologous and allogeneic stem cell transplant in Jehovah’s Witnesses: a single-center experience on 22 patients. Bone Marrow Transplant 51, 1002–1003 (2016). https://doi.org/10.1038/bmt.2016.29

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