Abstract
The major difficulty in the treatment of Jehovah’s Witnesses with haematological malignancies is the deny to the transfusion of blood products as support to chemo-radiotherapy; since the use of any form of bone marrow transplantation it is instead not precluded, this may be an alternative. From 1997 to July 2004 we treated 9 Jehovah’s Witnesses with de novo acute leukaemia without transfusions of blood products; in the same period 10 Jehovah’s Witnesses with various malignancies received high-dose therapy as conditioning to autologous PBSCT or allogeneic BMT. Acute leukaemia consisted of FAB-M3 4 patients (pts), FAB-M4 1 pt, FAB-L1 1 pt, FAB-L2 2 pts, FAB-L3 1 pt. Hb at diagnosis was 10.3g/dL mean (5.5–14.0 range), PLT at diagnosis were 40x10^3/μL mean (5–197 range). The mean age of pts was 26.2 years (2–49 range). The treatment consisted of protocols in use in our Institution at the time of diagnosis. The nadir of Hb was 5.3g/dL mean (1.3–8.3 range) and it was reached 10 days mean from start of therapy (1–16 days range); the nadir of PLT was 16x10^3/μL mean (0–70 range) and was reached 6 days mean from start of therapy (1–13 days range). The results to therapy show that 8/9 pts reached a CR and 1 died for anaemia during induction when the Hb was 1.3g/dL; at the follow-up 2 pts relapsed 3 and 8 months, respectively and died for disease progression, 6 pts are alive and in CR 12–60 months following the end of therapy. The patients undergoing high-dose therapy included NHL 1 pt, ALL 2 pts, CLL 1 pt, Breast Cancer 1 pt, CML chronic phase 1 pt, CML blastic phase 1 pt, MDS 1 pt, MM 1 pt and AML 1 pt; 6 of them received autologous PBSCT and 4 allogeneic BMT. Three pts were in CR following first-line therapy, 5 in relapse and 2 with progressive untreated disease. High-dose therapy consisted of classic Thiotepa and Melphalan, CTX and TBI, BEAM and Melphalan alone depending the disease. Hb before high-dose therapy was 12.2g/dL mean (6.2–14.0 range) and PLT were 186x10^3/μL mean (10–328 range). The nadir of Hb was 7.2g/dL mean (2.0–11.0 range) and that of PLT 6.0x10^3/μL (1–14 range). The recovery of reticulocytes (>20x10^3/μL) was reached at 12 days from HDT mean (7–22 range) and PLT (>20x10^3/μL) at 13 days mean (8–27 range). None of patients occurred major bleeding or complications due to anaemia. One pt died for acute GVHD 2 months following TMO, 3 pts died for disease progression and 6 pts are alive in CR 2–48 months following HDT. In conclusion this study demonstrates that therapy for acute leukaemia and high-dose therapy as conditioning to bone marrow transplant are feasible in patients refusing transfusions of blood products and the results are almost similar to comparable patients accepting blood transfusions.
Prognostic value of bone marrow angiogenesis in patients with multiple myeloma undergoing high-dose therapy
