Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Bloodless tandem autologous transplant in Jehovah’s Witness patients

Bone Marrow Transplantation volume 53, pages 1428–1433 (2018)Cite this article

Subjects

Abstract

Tandem autologous transplants are generally the preferred therapy for newly diagnosed intermediate- and high-risk myeloma patients. More Jehovah’s Witnesses (JW) are receiving single autologous peripheral blood stem cell transplants (PBSCTs). However, tandem autologous transplants have not been reported in JW patients. We performed a retrospective study of 54 patients, including four JW patients who received tandem autologous transplants between August 2000 and January 2017 and the last 50 consecutive tandem autologous transplants performed between August 2014 and August 2016. The bleeding complications, number, and cost of transfusions of blood products were compared. The median number of CD34 cells infused in non-JW patients was 8.16 million cells/kg versus 9.44 million cells/kg in JW patients. During the first 30 days, one JW experienced Grade III pulmonary hemorrhage, while none of the non-JW patients had a Grade III or higher bleeding problem. After tandem autologous transplants, complete remission was achieved in 88% of non-JW, compared with 75% in JW patients. In the first 30 days post-transplant, median platelet and packed red blood cell (PRBC) transfusions in non-JW patients was 2 (range: 0–40) and 1 (range: 0–11), respectively. Total cost of PRBC and platelet transfusions for the 50 non-JW was $214,664 (average $2147/transplant). Tandem autologous transplants can thus be performed safely without a single blood transfusion.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Bodnaruk ZM, Wong CJ, Thomas MJ. Meeting the clinical challenge of chare for Jehovah’s Witnesses. Transfus Med Rev. 2004;18:105–16.

    Article  Google Scholar 

  2. Brown NM, Matthews B, Ford PA. Treatment of a Jehovah’s Witness using a transfusion-free autologous stem cell transplant protocol. Community Oncol. 2006;3:776–80.

    Article  Google Scholar 

  3. Cuirea S, Beri R, Dobogai L, Chunduri S, Mahmud N, Rondelli D, et al. The use of blood conservation methods in addition to erythropoietin allows myeloablative allogeneic stem cell transplantation without the use of blood products [letter]. Bone Marrow Transplant. 2006;37:325–7.

    Article  Google Scholar 

  4. Ballen KK, Becker PS, Yeap BY, Matthews B, Henry DH, Ford PA. Autologous stem-cell transplantation can be performed safely without the use of blood-product support. J Clin Oncol. 2005;22:4087–94.

    Article  Google Scholar 

  5. Ronchetti AM, Isnard F, Buffet M, Coman T, Gorin NC, Coppo P, et al. Dexamethasone, cisplatin, doxorubicin, cyclophosphamide and etoposide (DPACE) is an effective salvage regimen for multiple myeloma refractory to novel agents. Leuk Lymphoma. 2013;54:1117–9.

    Article  CAS  Google Scholar 

  6. Nadiminti K, Singh Abbi KK, Mott SL, Dozeman L, Tricot A, Schultz A, Behrends S, Zhan F, Tricot G. VTD-melphalan is well tolerated and results in very high rates of stringent CR and MRD-negative status in multiple myeloma. Onco Targets Ther. 2017;10:217–26.

    Article  CAS  Google Scholar 

  7. Frere P, Hermanne JP, Debouge MH, Fillet G, Beguin Y. Changing pattern of bacterial susceptibility to antibiotics in hematopoietic stem cell transplant patients. Bone Marrow Transplant. 2002;29:589–94.

    Article  CAS  Google Scholar 

  8. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.

    Article  Google Scholar 

  9. Kariyawasan CC, Hughes DA, Jayatillake MM, Mehta AB. Multiple myeloma: causes and consequences of delay in diagnosis. QJM. 2007;100:635–40.

    Article  CAS  Google Scholar 

  10. Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: a report from the Haematological Malignancy Research Network. Br J Cancer. 2011;105:1684–92.

    Article  CAS  Google Scholar 

  11. Attal M, Horousseau J, Facon T, Guilhot F, Doyen C, Fuzibet J, et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med. 2003;349:2495–502.

    Article  CAS  Google Scholar 

  12. Dispenzieri A. Myeloma: management of the newly diagnosed high-risk patient. Hematology. 2016;494:485–94.

    Article  Google Scholar 

  13. Barlogie B, Mitchell A, van Rhee F, Epstein J, Morgan GJ, Crowley J. Curing myeloma at last: defining criteria and providing the evidence. Blood. 2014;124:3043–51.

    Article  CAS  Google Scholar 

  14. Rogers DM, Crookston KP. The approach to the patient who refuses blood transfusion. Transfusion. 2006;46:1471–7.

    Article  Google Scholar 

  15. Rodriquez MH. [Bloodless medicine (article in Spanish)]. Rev Med Inst Mex Sequro Soc. 2005;43:229–35.

    Google Scholar 

  16. Shander A, Javidrooz M, Perelman S, Puzio T, Lobel G. From bloodless surgery to patient blood management. Mt Sinai J Med. 2012;79:56–65.

    Article  Google Scholar 

  17. Frank SM, Wick SC, Dezern AE, Ness PM, Wasey JO, Pippa AC, et al. Risk-adjusted clinical outcomes in patients enrolled in a bloodless program. Transfusion. 2014;54 (10 pt 2):2668–77.

    Article  Google Scholar 

  18. Jabbour N, Gagandeep S, Mateo R, Sher L, Strum E, Donovan J, et al. Live donor liver transplantation without blood products: strategies developed for Jehovah’s Witnesses offer broad application. Ann Surg. 2004;240:350–7.

    Article  Google Scholar 

  19. Jabbour N, Gagandeep S, Meteo R, Sher L, Genyk Y, Selby R. Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah’s Witnesses. J Am Coll Surg. 2005;201:412–7.

    Article  Google Scholar 

  20. Boggi U, Vistoli F, Del Chiaro M, Croce C, Signori S, Marchetti P, et al. Kidney and pancreas transplants in Jehovah’s witnesses: ethical and practical implications. Transplant Proc. 2004;36:601–2.

    Article  CAS  Google Scholar 

  21. Laszio D, Agazzi A, Goldhirsch A, Cinieri S, Bertolini F, Rabascio C, et al. Tailored therapy of adult acute leukaemia in Jehovah’s Witnesses: unjustified reluctance to treat. Eur J Haematol. 2004;72:264–7.

    Article  Google Scholar 

  22. Brown NM, Kim SY, Ford PA. Autologous stem cell transplants in Jehovah’s Witnesses [letter]. Bone Marrow Transplant. 2009;44:391–2.

    Article  CAS  Google Scholar 

  23. Ford PA, Grant SJ, Mick R, Keck G. Autologous stem-cell transplantation without hematopoietic support for the treatment of hematologic malignancies in Jehovah’s Witnesses. J Clin Oncol. 2015;33:1674–9.

    Article  CAS  Google Scholar 

  24. Schmitt S, Mailaender V, Egerer G, Leo A, Becker S, Reinhardt P, et al. Successful autologous peripheral blood stem cell transplantation in a Jehovah’s Witness with multiple myeloma: review of literature and recommendations for high-dose chemotherapy without support of allogeneic blood products. Int J Hematol. 2008;87:289–97.

    Article  CAS  Google Scholar 

  25. Wandt H, Schaefer-Eckhart K, Wilhelm M. Two allogeneic hematopoietic stem cell transplantations without the use of blood-product support. Haematologica. 2005;90:1292–4.

    PubMed  Google Scholar 

  26. Zanz T, Dohner H, Bunies D. Transfusion-free reduced-intensity conditioned allogeneic stem cell transplantation in a Jehovah’s Witness. Bone Marrow Transplant. 2003;32:437–8.

    Article  Google Scholar 

  27. Mazza P, Prudenzana A, Amurri B, Palazzo G, Pisapia G, Stani L, et al. Myeloablative therapy and bone marrow transplantation in Jehovah’s Witnesses with malignancies: single center experience. Bone Marrow Transplant. 2003;32:433–6.

    Article  CAS  Google Scholar 

  28. Winslow RM. New frontiers in transfusion medicine. American Association of Blood Banks Teleconference 1995.

  29. Biopure Hemopure. Pharmaceutical approval monthly. F-D-C Rep. 2003;8:6.

    Google Scholar 

Download references

Acknowledgements

We acknowledge the nurses in the Clinical Cancer Center, specifically Sonya Behrends, Stephanie Palmer, and Jacque Gingerich, for their outstanding patient care. They would also like to acknowledge Jillna Patel for her excellent administrative assistance in preparing this manuscript.

Author information

Authors and Affiliations

  1. Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Rafiullah Khan, Y. S. Jethava & Guido Tricot

  2. Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Rafiullah Khan, Sarah L. Mott, Allyson Schultz, Y. S. Jethava & Guido Tricot

  3. Iowa Marrow Donor Program, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Allyson Schultz

Authors
  1. Rafiullah Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah L. Mott
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allyson Schultz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. S. Jethava
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guido Tricot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guido Tricot.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khan, R., Mott, S.L., Schultz, A. et al. Bloodless tandem autologous transplant in Jehovah’s Witness patients. Bone Marrow Transplant 53, 1428–1433 (2018). https://doi.org/10.1038/s41409-018-0132-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-018-0132-6

This article is cited by

Search

Advanced search

Quick links