Chemotherapy without Blood Products for Treatment of Acute Myelogenous Leukemia in an Anemic Jehovah's Witness Patient.

BACKGROUND Acute myelogenous leukemia (AML) is a rare, aggressive, disease that requires prolonged treatment. It accounts for a third of all leukemias diagnosed in the United States. A bone marrow biopsy accompanied by histological, cytogenetic, and molecular analysis is essential for the classification of malignancy. Jehovah's Witness members firmly refuse to take blood products, which significantly complicates the choice of chemotherapeutic regimens. Cytopenia is a known adverse effect of the standard on-label regimens for chemotherapy for AML. Several modifications to treatment plans have been reported to reduce bone marrow toxicity in fragile AML patients, including those who decline blood transfusions. CASE REPORT A Jehovah's Witness woman in her late twenties with a starting hemoglobin of 6.7 g/dL was admitted with a diagnosis of adverse risk AML. The inpatient chemotherapy included azacytidine and venetoclax. Post-treatment bone marrow showed residual leukemia with 10-15% blasts on day 28. On day 19, her hemoglobin level had reached a nadir of 3.7 g/dL. All of her consultations and care were given through a community hospital network. Ultimately, she completed 3 outpatient courses of monotherapy with azacytidine but elected to decline further treatment and died at home. CONCLUSIONS Refusal to grant consent to use blood products significantly complicates designing a chemotherapeutic regimen for AML, especially when the hemoglobin level is already critically low at the start of therapy. Customized treatment regimens utilizing alternative, off-label regimens may be necessary to achieve maximum clinical outcomes while minimizing potential adverse effects. Genetic-based methods, including molecularly targeted therapies, require further investigation.