A Jehovah's Witness with Acute Myeloid Leukemia Successfully Treated with an Epigenetic Drug, Azacitidine: A Clue for Development of Anti-AML Therapy Requiring Minimum Blood Transfusions.

Yumi Yamamoto,Akihito Kawashima,Kiyoyuki Ogata,Eri Kashiwagi

doi:10.1155/2014/141260

Abstract

Therapy for acute leukemia in Jehovah's Witnesses patients is very challenging because of their refusal to accept blood transfusions, a fundamental supportive therapy for this disease. These patients are often denied treatment for fear of treatment-related death. We present the first Jehovah's Witness patient with acute myeloid leukemia (AML) treated successfully with azacitidine. After achieving complete remission (CR) with one course of azacitidine therapy, the patient received conventional postremission chemotherapy and remained in CR. In the case of patients who accept blood transfusions, there are reports indicating the treatment of AML patients with azacitidine. In these reports, azacitidine therapy was less toxic, including hematoxicity, compared with conventional chemotherapy. The CR rate in azacitidine-treated patients was inadequate; however, some characteristics could be useful in predicting azacitidine responders. The present case is useful for treating Jehovah's Witnesses patients with AML and provides a clue for anti-AML therapy requiring minimum blood transfusions.

Highlights

Therapy for acute leukemia patients who refuse blood transfusions, which is a cardinal supportive therapy during the induction period [1], is very challenging
We reviewed acute myeloid leukemia (AML) patients who accepted blood transfusions and were treated with azacitidine in the literature to provide a clue for the development of anti-AML therapy requiring minimum blood transfusions
The case presented in this paper is the 16th Jehovah’s Witnesses patient with AML excluding acute promyelocytic leukemia (APL) who attained complete remission and the first Jehovah’s Witnesses patient with AML who was treated with azacitidine

Summary

Introduction

Therapy for acute leukemia patients who refuse blood transfusions, which is a cardinal supportive therapy during the induction period [1], is very challenging. These patients are often denied treatment for fear of treatment-related death. Sporadic AML patients treated successfully with azacitidine have been reported [5]. We present the first case of a Jehovah’s Witness with AML who was successfully treated with azacitidine without blood transfusion. We reviewed AML patients who accepted blood transfusions and were treated with azacitidine in the literature to provide a clue for the development of anti-AML therapy requiring minimum blood transfusions

Case Report

Literature Review

Discussion