Successful autologous peripheral blood stem cell transplantation in a Jehovah's Witness with multiple myeloma: review of literature and recommendations for high-dose chemotherapy without support of allogeneic blood products.
We present a case report of a successful high-dose melphalan therapy and autologous stem cell transplantation without the use of allogeneic blood product support in a 70-year-old patient suffering from multiple myeloma. Based on the experience in this case and thorough evaluation of the literature, we consider pre-transplant Hb level of 11-12 g/dl, platelet count higher than 70/nl, good WHO performance status of two and lower and informed consent as important eligibility criteria. During cytopenia recommended supportive measures include growth factor support with erythropoietin and G-CSF, p.o. iron treatment as well as prophylactic use of anti-fibrinloytic agents. Furthermore we discuss additional options that might be considered depending on the individual factors as e.g. pre-transplant collection and cryoconservation of autologous platelet concentrates. Moreover, an analysis of socio-economic issues regarding this procedure is presented. We conclude that allogeneic blood product free transplantation is a feasible procedure that can be offered to the patients belonging to distinct religious groups refusing allogeneic blood products as Jehovás Witnesses and patients presenting other contraindications for transfusions.
Schmitt
S
S
Department of Medicine V (Hematology/Oncology/Rheumatology), University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. stefan.schmitt@med.uni-heidelberg.de.
Mailaender
V
V
Egerer
G
G
Leo
A
A
Becker
S
S
Reinhardt
P
P
Wiesneth
M
M
Schrezenmeier
H
H
Ho
A D
AD
Goldschmidt
H
H
Moehler
T M
TM
D000368:Aged; D015925:Cryopreservation; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D010983:Plateletpheresis; D012074:Remission Induction; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous