Remission Induction Treatment for 6 Patients of Jehovah’s Witnesses with De Novo Acute Leukemia.

The treatment of acute leukemia with myelosuppressive chemotherapy usually requires the transfusions of blood and blood products. For religious reasons, Jehovah’s Witnesses (JW) do not consent to the transfusion of blood. We describe here six cases of JW with acute leukemia, who received induction chemotherapy without blood support.

From January 1996 to March 2006, six JW with newly diagnosed acute leukemia received remission induction chemotherapy at Shizuoka Red Cross Hospital or Kanagawa Cancer Center (acute myeloid leukemia (AML) n=5, acute lymphoblastic leukemia (ALL) n=1). All patients refused the consent for transfusions of packed red cells and platelet units and they were never forced accept them.

Remission induction therapy: One patient with M3 received all-trans retinoic acid alone. One ALL patient received prednisolone alone. Three AML patients received the following LVP regimen: L-asparaginase 5000U/sqm div from day 8 to day 21 + vincristine 1.4mg/sqm div day1, 6, 11, 16, 21, 26 + prednisolone 40mg/sqm div from day 1 to day 28, and one AML patient received a low dose of Ara-C regimen (20mg/sqm continuous div from day 1 to day 14).

Results (see Table): Four out of six patients achieved complete remission and two paitents died from cardiac arrest due to severe anemia before hematological recovery. No patients developed fatal bleeding complications, not even long lasting severe thrombocytopenia.

Conclusion: We have demonstrated the feasibility of remission induction therapy for JW with leukemia. This LVP regimen, or steroid based regimen, may be suitable for JW with acute leukemia because myelosuppression is relatively mild. While two patients experienced cardiac arrest due to severe anemia of under 3g/dL of hemoglobin, severe thrombocytopenia can be managed without prophylactic platelet transfusion.