Bloodless tandem autologous stem cell transplant for multiple myeloma in Jehovah's Witness patients.

Abstract

e19523 Background:, Cases of Jehovah’s Witnesses (JW) who undergo, and survive, autologous and allogeneic stem cell transplant(SCT) are increasingly reported. Tandem autologous stem cell transplantation(ASCT) for multiple myeloma has not been previously reported in JW. We are describing the first reports of four JW patients who successfully underwent tandem bloodless ASCT for multiple myeloma. Methods:, We retrospectively studied the outcome of four JW patients who underwent tandem ASCT from November 2000 to January 2017. . The bleeding complications, number and cost of transfusion of blood products were compared with last 100 consecutive tandem autologous transplants done from November 2014 till January 2017. Results:,There were 4 JW patients and 59 non-JW patients. Among 4 JW patients 3 were male and 1 was female. Among 59 non-JW 24(40.7%) were female and 35 (59.3%) were female. Median age was 60-years (range 54–66) and 59-years (range 36–71) for JW and non-JW patients, respectively. At Day+30 one JW patient had grade III pulmonary hemorrhage and Non-JW patients had no grade III or higher bleeding problems .The median number of CD34 cells transfused was 7.48 millions cells/kg in non-JW patients while it was 9.44 millions/kg in JW patients. Complete Remission(CR) was achieved in 33(59%) after 1st tandem and 35(81.4%) after the second tandem transplant in Non-JW patients as compared to 100% CR rate in JW patients . The median number of platelet transfusions in non-JW patients was 2(range 0—21) and PRBC units was 1(range 0—7) at day+30 . Total cost of PRBC and platelet transfusions for the 59 non-JW patients was ~ 192,374 dollars (average 1923.74$/transplant). This excludes the supply costs and management of transfusion reactions costs. Conclusions: 1) Tandem autologous transplant for multiple myeloma in JW population is practical and largely safe. 2) Blood products are expensive and can be further minimized based on the JW patient data