The Jehovah’s Witness religious movement is a Christian sect with over 2.6 million followers worldwide that forbids the transfusion of blood and blood components to its members. There is limited experience in the treatment of Jehovah’s Witnesses with acute myeloid leukemia (AML). Treatment of patients, who do not accept required blood support on religious grounds, is always a difficult problem. This dilemma is of particular concern in cases such as acute leukemia in which the physician himself, by choosing and applying appropriate treatment, may increase the need for transfusion support.
The standard treatment for AML is seven days of an anthracycline and three days of cytarabine (7 + 3); with this regimen 70–80% of young adults and 40–60% of older adults, will achieve complete remission. The combination of cytarabine plus an anthracycline results in severe pancytopenia and therefore requires transfusion support. During induction chemotherapy, patients are given an average of 10.8 units of red blood cell concentrates and 8.5 platelet transfusions over a period of about 30 days.
Corsetti et al. described a chemotherapy regimen designed for elderly AML patients that had low hematological toxicity, and response rates of 36%. In this setting, another drug, azacytidine is used to treat AML in elderly or fragile patients who are not candidates for an intensive chemotherapy regimen. However, since azacytidine was not available at our institution due to financial restrictions, we administered a combination of low-dose cytarabine plus valproic acid to our patient after she rejected standard AML therapy.
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