Acute leukaemia in Jehovah's Witnesses

Abstract

Summary. The refusal of Jehovah's Witnesses with leukaemia to accept transfusion provides a major clinical challenge because of the myelosuppressive effects of chemotherapy. Experience in treating five such patients is described. Two patients with acute lymphoblastic leukaemia (ALL) achieved remission following chemotherapy, the first without transfusion support, the second, a minor, receiving transfusion under a court order; the first patient remains in remission 5 years later, whereas the second subsequently relapsed and died. Of three patients with acute myeloid leukaemia (AML), two received chemotherapy: one died of anaemia during induction chemotherapy whereas the second eventually consented to transfusion but died of refractory leukaemia.The third patient died of anaemia despite erythropoietin. We feel Jehovah's Witnesses should not be denied antileukaemic therapy if they fully understand the risks involved. Minimizing phlebotomy, use of antifibrinolytic agents and growth factors may make chemotherapy feasible, especially in ALL where remission may be induced with less myelosuppressive agents. The outlook for those with AML treated with conventional chemotherapy appears poor; alternative approaches to treatment should be considered in these patients.

Oncological Management of Pediatric Cancer Patients Belonging to Jehovah’s Witnesses: A Two-Institutional Experience Report

“…The therapeutic outcomes of these studies showed a great variation with a high percentage of death due to treatment-induced anemia or disease relapse [4,14,29]. Successful outcomes of treatment did also occur, but these were dependent on the type of leukemia to be treated and on the degree of treatment-related bone marrow aplasia [4,5,14,19,20,22]. However, all data suggest that severe and long-lasting bone marrow aplasia might not in general counteract the idea of transfusion-free oncological treatment regimens.…”

“…Some patients survive even intensive chemotherapy without transfusions [2,3]. So far, only a few cancer treatments in pediatric patients of Jehovah's Witnesses were described [4][5][6][7][8].…”

Myeloablative therapy and bone marrow transplantation in Jehovah's Witnesses with malignancies: single center experience

“…Reports concerning leukemia in Jehovah's Witnesses show that the achievement of remission with a heavy therapy is possible, [1][2][3][4] and this may be curative; however, many ethical implications are raised by investigators, mainly concerning the choice whether to treat or not to treat and, if so, what appropriate therapy is to be performed. Almost all our patients, before the transplant procedure, received a standard therapy, except two patients who received a shortened course of therapy to avoid a long duration of myelosuppression.…”

“…Frequently, physicians refuse to take care of these patients or they propose less aggressive therapies than expected in these diseases. 1 However, there are several reports emphasizing that the cure of leukemia is possible, also without the support of transfusions, 2-4 but single case reports are very anecdotal and there are no sequential studies reported. Although Jehovah's Witnesses deny blood transfusions, they often accept bone marrow or peripheral blood stem cell support.…”

Faith and Freedom: Leukemia in Jehovah Witness Minors

“…While treating any patient with acute leukemia involves a balance between treating the disease and avoiding treatment toxicity, this balance becomes much more tenuous for patients who refuse blood products. Recent case studies report success in treating Jehovah's Witness leukemia patients [15][16][17]. Alltrans retinoic acid (ATRA) combined with arsenic trioxide has been used with minimal hematological toxicity for patients with acute promyelocytic leukemia (APML), however, only 10% of adults with acute myeloid leukemia have this FAB subtype [16].…”