Faculty Collaboration Database

A single-institution experience of performing bloodless transplant in Jehovah's Witness patients. Hematol Oncol Stem Cell Ther 2019 Mar;12(1):44-49

Date

01/04/2019

Pubmed ID

30605629

DOI

10.1016/j.hemonc.2018.11.003

Scopus ID

2-s2.0-85059446608 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

OBJECTIVE/BACKGROUND: Autologous stem cell transplant has been shown to prolong survival in multiple myeloma (MM). A common complication of the pre-transplant conditioning chemotherapy is severe multi-lineage cytopenias, resulting in significant transfusion requirements. Jehovah's Witnesses are members of a religious group that do not accept the transfusion of blood products. Many large transplant centers refuse to perform transplantation in Jehovah's Witnesses due to the complexity of treating cytopenic patients without blood product transfusions. However, some transplant centers that specialize in "bloodless" medicine and surgery have successfully transplanted in Jehovah's Witnesses without transfusion support.

METHODS: In order to maximize successful outcomes in this population, potential transplant candidates are treated with a variety of agents to maximize baseline hemoglobin and platelet counts. In preparation for the first two "bloodless" transplants for MM at our institution, we conducted a retrospective study of patients with MM who underwent a transplant in the preceding year.

RESULTS: Of the 60 patients reviewed, only six required packed red blood cell transfusion, whereas 39 required at least one platelet transfusion. These findings helped us to design a novel protocol for a "bloodless" autologous transplant. We administered romiplostim, a thrombopoietin (TPO) agonist, along with aminocaproic acid, desmopressin, and vitamin K post-transplant to two Jehovah's Witness patients to mitigate the risk of thrombocytopenia. Neither patient experienced significant bleeding nor qualified for platelet transfusion, and underwent successful and uncomplicated transplantation.

CONCLUSION: We propose that the use of romiplostim or similar TPO agonists can be used to maximize the chance of a successful "bloodless" transplant for stem cell recipients.

Author List

Coltoff A, Shreenivas A, Afshar S, Steinberg A

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aminocaproic Acid
Autografts
Deamino Arginine Vasopressin
Female
Humans
Jehovah's Witnesses
Male
Middle Aged
Multiple Myeloma
Receptors, Fc
Recombinant Fusion Proteins
Stem Cell Transplantation
Thrombopoietin
Vitamin K