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Posted: January 5, 2003

Addenda:

 

In Jehovah's Witnesses with acute myelocytic leukemia (AML), what are the chances that intensive chemotherapy without blood component support will induce a sustained remission?

A colleague in Australia wants to know if anyone has data regarding survival rates of Jehovah's Witnesses who require high dose chemotherapy for treatment of AML. The Australian colleague is interested in data regarding INITIAL aggressive therapy for AML, not transplantation. He would appreciate any, even anecdotal comments from the network.

In response to the above query, a Canadian colleague who monitors literature for the Jehovah's Witnesses provided the following list of references and a few comments. Here are his comments "We monitor the clinical literature on various blood transfusion-related issues and do not have access to data from various hospitals or clinicians. (That would be ideal for everyone for all illnesses, but alas it is not an ideal world. Nonetheless, here are a few citations for management of AML in Jehovah's Witnesses. The long-term disease-free survival of AML patients in general is dismal. (The intensive chemotherapy is no fun either.) These papers reveal the outcomes are likewise disappointing. There appears to be some promise in either (i) nonmyeloablative stem cell transplantation, or (ii) immunotherapy for AML patients."

Here are the references that were provided.

  1. Broccia G. Long-term continuous complete remission of acute myeloid leukemia in a Jehovah's Witness treated without blood support. Haematologica 1994;79(2)180-1.
  2. Mazza P, Palazzo G, Amurri B, et al. Acute leukemia in Jehovah's Witnesses a challenge for hematologists (letter). Haematologica 2000;85(11)1221-2.
  3. Bueno J, Zuazu J, Villalba T, Julia A. Acute leukaemia in Jehovah's Witnesses (electronic letter). Haematologica 2001;86(2)E02.
  4. Goldberg SL, Chan CS, Dawkins FW, et al. Should Jehovah's Witnesses be denied intensive chemotherapy for acute leukemia? (letter). N Engl J Med 1990;322(11)777-8.
  5. Ruiz-Arguelles GJ, Gomez-Almaguer D, Ruiz-Arguelles A, et al. Results of an outpatient-based stem cell allotransplant program using nonmyeloablative conditioning regimens. Am J Hematol 2001;66(4)241-4.
  6. Ballen KK, Ford PA, Waitkus H. Successful autologous bone marrow transplant without the use of blood product support. Bone Marrow Transplant 2000;26(2)227-9.
  7. Bachleitner-Hofman T, Gisslinger B, Grumbeck E, Gisslinger H. Arsenic trioxide and ascorbic acid synergy with potential implications for the treatment of acute myeloid leukemia? Br J Haematol 2001;112(3)783-6.
  8. Ford P. Management of hematologic disorders without the use of blood products. In Blood Conservation and Transfusion Alternatives symposium at 28th World Congress of the International Society of Hematology, Toronto, Ontario, Canada. 2000 Aug 26. (Symposium syllabus)
  9. Cullis et al. Acute leukemia in Jehovah's Witnesses (review). Br J Haematol 1998;100(4)664-8.
  10. Marsh et al. Hematological care of the Jehovah's Witness patient (review). Br J Haematol 2002;119(1)25-37.

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