Patients with non-Hodgkin's lymphoma, Hodgkin's lymphoma, and multiple myeloma who refuse blood products can receive autologous stem-cell transplantation, thanks to a procedure developed by The Center for Bloodless Medicine & Surgery at Pennsylvania Hospital in Philadelphia.
So why not just opt for an autologous stem-cell transplant? Well, for those patients with specific religious beliefs who object to receiving blood products (including their own) or for those who have reservations about the potential risks associated with blood-borne complications, we now have another option.
For Mr. S., after a recurrence of stage 4A diffuse large cell non-Hodgkin's lymphoma, a local bone marrow transplant center felt his only option for treatment was a stem cell transplant. But after the patient refused to receive any kind of blood products, the transplant center also refused to treat him and he was then referred to The Center for Bloodless Medicine & Surgery at Pennsylvania Hospital.
Performing the first no-transfusion stem-cell transplant more than 15 year ago, Dr. Patricia Ford, director of the hospital's Center for Bloodless Medicine and Surgery, said that bloodless transplants are not only an option for Jehovah's Witnesses, it's also a way to avoid unnecessary transfusions and its associated risks, along with reducing costs.
After initial evaluation there, he was found to be an appropriate candidate for the procedure, and a pheresis catheter was placed and cytokine mobilization of hematopoietic cells was initiated.
After admission to the hospital, he was started on high-dose busulfan, cyclophosphamide, and etoposide (BCV) therapy. Over the following two weeks he became severely pancytopenic and developed neutropenic fevers, requiring treatment with IV antibiotics. He also developed GI toxicity with mucositis and diarrhea.
Prior to transplant, he was given iron and growth factors, resulting in baseline hemoglobin of 12--limiting blood tests may have helped in minimized blood loss as well. His hemoglobin dropped to 6, requiring monitored care to provide volume support and monitor cardiac function.
Due to Mr. S's low platelet count (less than 10K), he was treated with prophylactic vitamin K and aminocaproic acid (Amicar) and interleukin 11 to help stimulate platlet growth. There were no episodes of bleeding, and by day 12 he had partial cell grafting. He was discharged with a follow-up to his oncologist, and has remained in remission two years post-transplant.
Not only do Ford's techniques have a lower mortality rate, the patients are generally discharged a day sooner than the patients who receive blood products.
Are any of your facilities performing bloodless stem cell transplants? If so, what kind of results are you seeing?