The Safety of Performing Bloodless Autologous Stem Cell Transplantation in Jehovah's Witness Patients.

Abstract

<h3>Introduction</h3> Due to the curative potential and improvement in progression-free survival (PFS), high dose chemotherapy followed by autologous stem cell transplantation (ASCT) is considered the standard of care for several hematologic malignancies such as multiple myeloma, and lymphomas in different treatment stages. However, the process of ASCT typically involves support with blood product transfusion until neutrophil and platelet engraftment occurs. Thus, difficulties arise when ASCT is indicated for Jehovah's witness patients - a religious group known for refusing blood products. <h3>Objectives</h3> 1. Assess for differences in overall survival between BL-ASCT and TS-ASCT. 2. Outline the key complications associated with BL-ASCT. <h3>Methods</h3> Retrospective analysis of 66 Jehovah's Witnesses who underwent BL-ASCT, and 1114 non-Jehovah's Witness patients who underwent transfusion-supported ASCT (TS-ASCT) at Cedars-Sinai Medical Center between January 2000 and September 2018 was performed. Patients included in the study had one of the following diagnoses: multiple myeloma, non-Hodgkin's lymphoma, Hodgkin's lymphoma, or germ cell tumor. The BL-ASCT group received supportive measures to minimize bleeding risk and blood loss (detailed in table 1). Overall survival was estimated using the Kaplan-Meier method. Transplant-related complications were characterized for the BL-ASCT group. <h3>Results</h3> One year overall survival (OS) was found to be 87.9% for both groups (P = 0.92). Survival at five years for the BL-ASCT group was 72.7%, and 69.0% for the TS-ASCT (P = 0.79). In the BL-ASCT group, there was one death prior to the 30 days post-transplant due to CNS hemorrhage, and one death prior to 100 days due to sepsis. <h3>Conclusion</h3> Given that overall survival is not significantly different between BL-ASCT and TS-ASCT at the 1-year and 5-year marks, we encourage transplant centers to consider performing bloodless transplants in select patients with appropriate supportive measures. Future directions include analysis of overall differences in the financial burden between BL-ASCT and TS-ASCT, and further refinement of supportive care measures.