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Erschienen in: Supportive Care in Cancer 10/2010

01.10.2010 | Original Article

Bloodless cancer treatment results of patients who do not want blood transfusion: single center experience of 77 cases

verfasst von: Sung Yong Oh, Sung-Hyun Kim, Hyuk-Chan Kwon, Suee Lee, Kyeong Hee Kim, Kyung A Kwon, Jong-Hwan Lee, Kyu-Yeol Lee, Hyo-Jin Kim

Erschienen in: Supportive Care in Cancer | Ausgabe 10/2010

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Abstract

Purpose

Certain patients may be unwilling to accept blood products for religious reasons. In this study, we have assessed the clinical cancer treatment outcomes of Jehovah’s Witnesses (JW) cancer patients in order to identify the risks associated with their treatment, as well as their transfusion needs.

Methods

We analyzed 77 cases of histologically confirmed cancer patients (JW) from January 2001 to April 2008.

Results

The median age of the patients was 59 years (range, 8–83 years). The most common primary site was the stomach (20.8%), followed by the breast (14.3%), and colorectal region (11.7%). Operations were performed on 44 patients (89.8%). Changes in complete blood count profiles after operation were detected in the patients’ hemoglobin (mean ± SD; 12.7 ± 2.1 g/dL to 10.6 ± 2.3 g/dL, P < 0.001). Twenty-six patients received adjuvant chemotherapy. Among these, 21 (80.8%) completed their planned schedule. One hundred twenty-seven cycles of palliative intravenous chemotherapy were administered to 19 patients. Granulocyte-colony stimulating factor and erythropoietin were used in 45 and 20 cycles of treatment, respectively. Grade ≥III thrombocytopenia and anemia were noted in 3.9% and 2.4% of the patients. Three- and 5-year survival rates were 80% and 70%, respectively. The most frequent cause of death was disease progression rather than bleeding.

Conclusions

Bloodless cancer operation and chemotherapy were not accompanied by serious complications. A few cases of palliative chemotherapy also required transfusions. A prospective cohort study group will need to be used to determine precisely the safety of bloodless cancer treatment and the efficacy of transfusion alternatives.
Literatur
1.
Zurück zum Zitat Goodnough LT, Shander A, Spence R (2003) Bloodless medicine: clinical care without allogeneic blood transfusion. Transfusion 43:668–676CrossRefPubMed Goodnough LT, Shander A, Spence R (2003) Bloodless medicine: clinical care without allogeneic blood transfusion. Transfusion 43:668–676CrossRefPubMed
2.
Zurück zum Zitat Schmitt S, Mailaender V, Egerer G, Leo A, Becker S, Reinhardt P, Wiesneth M, Schrezenmeier H, Ho AD, Goldschmidt H, Moehler TM (2008) 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. Int J Hematol 87:289–297CrossRefPubMed Schmitt S, Mailaender V, Egerer G, Leo A, Becker S, Reinhardt P, Wiesneth M, Schrezenmeier H, Ho AD, Goldschmidt H, Moehler TM (2008) 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. Int J Hematol 87:289–297CrossRefPubMed
3.
Zurück zum Zitat Brown JE, Hatton MQ, Melchers R, Goldstraw P, Coleman RE (2003) Chemotherapy, erythropoietin and bloodless surgery in a Jehovah’s Witness. Clin Oncol (R Coll Radiol) 15:371–377 Brown JE, Hatton MQ, Melchers R, Goldstraw P, Coleman RE (2003) Chemotherapy, erythropoietin and bloodless surgery in a Jehovah’s Witness. Clin Oncol (R Coll Radiol) 15:371–377
4.
Zurück zum Zitat Johnson PW, King R, Slevin ML, White H (1991) The use of erythropoietin in a Jehovah’s Witness undergoing major surgery and chemotherapy. Br J Cancer 63:476PubMed Johnson PW, King R, Slevin ML, White H (1991) The use of erythropoietin in a Jehovah’s Witness undergoing major surgery and chemotherapy. Br J Cancer 63:476PubMed
5.
Zurück zum Zitat Brown NM, Keck G, Ford PA (2008) Acute myeloid leukemia in Jehovah Witnesses. Leuk Lymphoma 49:817–820CrossRefPubMed Brown NM, Keck G, Ford PA (2008) Acute myeloid leukemia in Jehovah Witnesses. Leuk Lymphoma 49:817–820CrossRefPubMed
6.
Zurück zum Zitat Ball AM, Winstead PS (2008) Recombinant human erythropoietin therapy in critically ill Jehovah’s Witnesses. Pharmacotherapy 28:1383–1390CrossRefPubMed Ball AM, Winstead PS (2008) Recombinant human erythropoietin therapy in critically ill Jehovah’s Witnesses. Pharmacotherapy 28:1383–1390CrossRefPubMed
7.
Zurück zum Zitat Monk TG (2004) Preoperative recombinant human erythropoietin in anemic surgical patients. Crit Care 8(Suppl 2):S45–S48CrossRefPubMed Monk TG (2004) Preoperative recombinant human erythropoietin in anemic surgical patients. Crit Care 8(Suppl 2):S45–S48CrossRefPubMed
8.
Zurück zum Zitat Mercuriali F, Inghilleri G (1998) Blood transfusion in oncologic surgery: the role of recombinant human erythropoietin (rHuEPO). Tumori 84:S3–S14PubMed Mercuriali F, Inghilleri G (1998) Blood transfusion in oncologic surgery: the role of recombinant human erythropoietin (rHuEPO). Tumori 84:S3–S14PubMed
9.
Zurück zum Zitat Gohel MS, Bulbulia RA, Slim FJ, Poskitt KR, Whyman MR (2005) How to approach major surgery where patients refuse blood transfusion (including Jehovah’s Witnesses). Ann R Coll Surg Engl 87:3–14CrossRefPubMed Gohel MS, Bulbulia RA, Slim FJ, Poskitt KR, Whyman MR (2005) How to approach major surgery where patients refuse blood transfusion (including Jehovah’s Witnesses). Ann R Coll Surg Engl 87:3–14CrossRefPubMed
10.
Zurück zum Zitat Gomez-Almaguer D, Ruiz-Arguelles G, Lozano de la Vega A, Garcia-Guajardo BM (1990) Acute leukemia in Jehovah’s Witnesses: difficulties in its management. Rev Invest Clin 42:317–320PubMed Gomez-Almaguer D, Ruiz-Arguelles G, Lozano de la Vega A, Garcia-Guajardo BM (1990) Acute leukemia in Jehovah’s Witnesses: difficulties in its management. Rev Invest Clin 42:317–320PubMed
11.
Zurück zum Zitat Chigbu B, Onwere S, Kamanu C, Aluka C, Okoro O, Feyi-Waboso P, Onichakwe C (2009) Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah’s Witness women presenting in the extremis with ruptured uterus. Arch Gynecol Obstet 279:469–472CrossRefPubMed Chigbu B, Onwere S, Kamanu C, Aluka C, Okoro O, Feyi-Waboso P, Onichakwe C (2009) Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah’s Witness women presenting in the extremis with ruptured uterus. Arch Gynecol Obstet 279:469–472CrossRefPubMed
12.
Zurück zum Zitat Adelola OA, Ahmed I, Fenton JE (2008) Management of Jehovah’s Witnesses in otolaryngology, head and neck surgery. Am J Otolaryngol 29:270–278CrossRefPubMed Adelola OA, Ahmed I, Fenton JE (2008) Management of Jehovah’s Witnesses in otolaryngology, head and neck surgery. Am J Otolaryngol 29:270–278CrossRefPubMed
13.
Zurück zum Zitat Rosengart TK, Helm RE, DeBois WJ, Garcia N, Krieger KH, Isom OW (1997) Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah’s Witness patients: implications for a "bloodless" surgical technique. J Am Coll Surg 184:618–629PubMed Rosengart TK, Helm RE, DeBois WJ, Garcia N, Krieger KH, Isom OW (1997) Open heart operations without transfusion using a multimodality blood conservation strategy in 50 Jehovah’s Witness patients: implications for a "bloodless" surgical technique. J Am Coll Surg 184:618–629PubMed
14.
Zurück zum Zitat Jabbour N, Gagandeep S, Mateo R, Sher L, Genyk Y, Selby R (2005) Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah’s Witnesses. J Am Coll Surg 201:412–417CrossRefPubMed Jabbour N, Gagandeep S, Mateo R, Sher L, Genyk Y, Selby R (2005) Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah’s Witnesses. J Am Coll Surg 201:412–417CrossRefPubMed
15.
Zurück zum Zitat Sloan JM, Ballen K (2008) SCT in Jehovah’s Witnesses: the bloodless transplant. Bone Marrow Transplant 41:837–844CrossRefPubMed Sloan JM, Ballen K (2008) SCT in Jehovah’s Witnesses: the bloodless transplant. Bone Marrow Transplant 41:837–844CrossRefPubMed
16.
Zurück zum Zitat Smith SE, Toor A, Rodriguez T, Stiff P (2006) The administration of polymerized human hemoglobin (Pyridoxylated) to a Jehovah’s Witness after submyeloablative stem cell transplantation complicated by delayed graft failure. Compr Ther 32:172–175CrossRefPubMed Smith SE, Toor A, Rodriguez T, Stiff P (2006) The administration of polymerized human hemoglobin (Pyridoxylated) to a Jehovah’s Witness after submyeloablative stem cell transplantation complicated by delayed graft failure. Compr Ther 32:172–175CrossRefPubMed
17.
Zurück zum Zitat Bengala C, Guarneri V, Ledermann J, Rosti G, Wandt H, Lotz JP, Cure JH, Orlandini C, Ferrante P, Conte PF, Demirer T (2005) High-dose chemotherapy with autologous haemopoietic support for advanced ovarian cancer in first complete remission: retrospective analysis from the Solid Tumour Registry of the European Group for Blood and Marrow Transplantation (EBMT. Bone Marrow Transplant 36:25–31CrossRefPubMed Bengala C, Guarneri V, Ledermann J, Rosti G, Wandt H, Lotz JP, Cure JH, Orlandini C, Ferrante P, Conte PF, Demirer T (2005) High-dose chemotherapy with autologous haemopoietic support for advanced ovarian cancer in first complete remission: retrospective analysis from the Solid Tumour Registry of the European Group for Blood and Marrow Transplantation (EBMT. Bone Marrow Transplant 36:25–31CrossRefPubMed
18.
Zurück zum Zitat Ballen KK, Ford PA, Waitkus H, Emmons RV, Levy W, Doyle P, Stewart FM, Quesenberry PJ, Becker PS (2000) Successful autologous bone marrow transplant without the use of blood product support. Bone Marrow Transplant 26:227–229CrossRefPubMed Ballen KK, Ford PA, Waitkus H, Emmons RV, Levy W, Doyle P, Stewart FM, Quesenberry PJ, Becker PS (2000) Successful autologous bone marrow transplant without the use of blood product support. Bone Marrow Transplant 26:227–229CrossRefPubMed
19.
Zurück zum Zitat Witzig TE, Silberstein PT, Loprinzi CL, Sloan JA, Novotny PJ, Mailliard JA, Rowland KM, Alberts SR, Krook JE, Levitt R, Morton RF (2005) Phase III, randomized, double-blind study of epoetin alfa compared with placebo in anemic patients receiving chemotherapy. J Clin Oncol 23:2606–2617CrossRefPubMed Witzig TE, Silberstein PT, Loprinzi CL, Sloan JA, Novotny PJ, Mailliard JA, Rowland KM, Alberts SR, Krook JE, Levitt R, Morton RF (2005) Phase III, randomized, double-blind study of epoetin alfa compared with placebo in anemic patients receiving chemotherapy. J Clin Oncol 23:2606–2617CrossRefPubMed
20.
Zurück zum Zitat Littlewood TJ, Bajetta E, Nortier JW, Vercammen E, Rapoport B (2001) Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 19:2865–2874PubMed Littlewood TJ, Bajetta E, Nortier JW, Vercammen E, Rapoport B (2001) Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 19:2865–2874PubMed
21.
Zurück zum Zitat Gabrilove JL, Cleeland CS, Livingston RB, Sarokhan B, Winer E, Einhorn LH (2001) Clinical evaluation of once-weekly dosing of epoetin alfa in chemotherapy patients: improvements in hemoglobin and quality of life are similar to three-times-weekly dosing. J Clin Oncol 19:2875–2882PubMed Gabrilove JL, Cleeland CS, Livingston RB, Sarokhan B, Winer E, Einhorn LH (2001) Clinical evaluation of once-weekly dosing of epoetin alfa in chemotherapy patients: improvements in hemoglobin and quality of life are similar to three-times-weekly dosing. J Clin Oncol 19:2875–2882PubMed
22.
Zurück zum Zitat Osterborg A, Brandberg Y, Molostova V, Iosava G, Abdulkadyrov K, Hedenus M, Messinger D (2002) Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin Beta, in hematologic malignancies. J Clin Oncol 20:2486–2494CrossRefPubMed Osterborg A, Brandberg Y, Molostova V, Iosava G, Abdulkadyrov K, Hedenus M, Messinger D (2002) Randomized, double-blind, placebo-controlled trial of recombinant human erythropoietin, epoetin Beta, in hematologic malignancies. J Clin Oncol 20:2486–2494CrossRefPubMed
23.
Zurück zum Zitat Lind M, Vernon C, Cruickshank D, Wilkinson P, Littlewood T, Stuart N, Jenkinson C, Grey-Amante P, Doll H, Wild D (2002) The level of haemoglobin in anaemic cancer patients correlates positively with quality of life. Br J Cancer 86:1243–1249CrossRefPubMed Lind M, Vernon C, Cruickshank D, Wilkinson P, Littlewood T, Stuart N, Jenkinson C, Grey-Amante P, Doll H, Wild D (2002) The level of haemoglobin in anaemic cancer patients correlates positively with quality of life. Br J Cancer 86:1243–1249CrossRefPubMed
24.
Zurück zum Zitat Dronca RS, Steensma DP (2008) VTE and mortality associated with erythropoiesis-stimulating agents in cancer-associated anemia. Nat Clin Pract Oncol 5:504–505CrossRefPubMed Dronca RS, Steensma DP (2008) VTE and mortality associated with erythropoiesis-stimulating agents in cancer-associated anemia. Nat Clin Pract Oncol 5:504–505CrossRefPubMed
25.
Zurück zum Zitat Thomas G, Ali S, Hoebers FJ, Darcy KM, Rodgers WH, Patel M, Abulafia O, Lucci JA 3rd, Begg AC (2008) Phase III trial to evaluate the efficacy of maintaining hemoglobin levels above 12.0 g/dL with erythropoietin vs above 10.0 g/dL without erythropoietin in anemic patients receiving concurrent radiation and cisplatin for cervical cancer. Gynecol Oncol 108:317–325CrossRefPubMed Thomas G, Ali S, Hoebers FJ, Darcy KM, Rodgers WH, Patel M, Abulafia O, Lucci JA 3rd, Begg AC (2008) Phase III trial to evaluate the efficacy of maintaining hemoglobin levels above 12.0 g/dL with erythropoietin vs above 10.0 g/dL without erythropoietin in anemic patients receiving concurrent radiation and cisplatin for cervical cancer. Gynecol Oncol 108:317–325CrossRefPubMed
26.
Zurück zum Zitat Wright JR, Ung YC, Julian JA, Pritchard KI, Whelan TJ, Smith C, Szechtman B, Roa W, Mulroy L, Rudinskas L, Gagnon B, Okawara GS, Levine MN (2007) Randomized, double-blind, placebo-controlled trial of erythropoietin in non-small-cell lung cancer with disease-related anemia. J Clin Oncol 25:1027–1032CrossRefPubMed Wright JR, Ung YC, Julian JA, Pritchard KI, Whelan TJ, Smith C, Szechtman B, Roa W, Mulroy L, Rudinskas L, Gagnon B, Okawara GS, Levine MN (2007) Randomized, double-blind, placebo-controlled trial of erythropoietin in non-small-cell lung cancer with disease-related anemia. J Clin Oncol 25:1027–1032CrossRefPubMed
Metadaten
Titel
Bloodless cancer treatment results of patients who do not want blood transfusion: single center experience of 77 cases
verfasst von
Sung Yong Oh
Sung-Hyun Kim
Hyuk-Chan Kwon
Suee Lee
Kyeong Hee Kim
Kyung A Kwon
Jong-Hwan Lee
Kyu-Yeol Lee
Hyo-Jin Kim
Publikationsdatum
01.10.2010
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 10/2010
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-009-0759-3

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