Laszlo Daniele, Agazzi Alberto, Goldhirsch Aron, Cinieri Saverio, Bertolini Francesco, Rabascio Cristina, Pruneri Giancarlo, Calabrese Liliana, Cocquio Angela, Martinelli Giovanni
Division of Hematology-Oncology, Department of Medicine, European Institute of Oncology, Milan, Italy.
Eur J Haematol. 2004 Apr;72(4):264-7. doi: 10.1111/j.0902-4441.2003.00211.x.
Treatment of acute leukaemia in adult Jehovah's Witnesses (JW) is challenging because of 'a priori' refusal of most physicians to apply diagnostic and therapeutic procedures to haematological abnormalities resembling acute leukaemia. Rejection of blood transfusions by individuals of this faith is usually blamed to justify this attitude, thus leading to severe personal, medical and psychological distress related to the lack of care. We therefore intended to verify whether a standard (tailored) chemotherapy, without the use of prophylactic blood product transfusions, could be applied during treatment of acute leukaemia under such circumstances. Eleven consecutive JW adult patients with acute leukaemia, all of whom had been denied care in other institutions, were treated at the European Institute of Oncology (EIO) in Milan, Italy. Five had acute lymphoblastic leukaemia (ALL) (one bcr/abl positive), six had acute myeloid leukaemia (AML) with immunophenotype and/or cytogenetic intermediate-high risk features, except one patient with acute promyelocytic leukaemia (APML). Standard induction chemotherapy [cytosine arabinoside (ARA-C) and daunorubicin (DNR) for AML, vincristine (VCR), DNR and prednisone (PDN) for ALL, all-trans retinoic acid (ATRA) and DNR for APML] with the antracycline dose of at least 30 mg/sqm were used. All patients experienced severe anaemia after induction chemotherapy despite erythropoietin. Median haemoglobin nadir for patients with ALL and AML was 4.5 g/dL (range 1.3-6.9) and 5.1 g/dL (range 2.6-6.8), respectively. Median platelet nadir counts for all patients was 14.5 x 10(9))/L (range 1-24). One patient died during induction probably due to haemorrhage. Four of five patients with ALL achieved a complete remission (CR) (including the bcr/abl case) while among patients with AML only the one with APML achieved CR. Three patients (APML = 1 and ALL = 2) are still alive and disease-free. This small series of adult patients with leukaemia illustrates difficulties in treating patients who are practising JW, yet nevertheless provides a significant argument against the prejudicial decision leading to evasion of treatment in these patients.
在成年耶和华见证人中治疗急性白血病颇具挑战性，因为大多数医生“先验地”拒绝针对类似急性白血病的血液学异常采用诊断和治疗程序。该宗教信仰的个体拒绝输血通常被视为这种态度的正当理由，进而导致因缺乏治疗而产生严重的个人、医疗和心理困扰。因此，我们旨在验证在这种情况下，不使用预防性血液制品输血的标准（定制）化疗是否可用于急性白血病的治疗。11例连续的成年耶和华见证急性白血病患者，均在其他机构被拒绝治疗，在意大利米兰的欧洲肿瘤研究所（EIO）接受治疗。5例患有急性淋巴细胞白血病（ALL）（1例bcr/abl阳性），6例患有急性髓细胞白血病（AML），具有免疫表型和/或细胞遗传学中高危特征，其中1例为急性早幼粒细胞白血病（APML）。采用标准诱导化疗[AML用阿糖胞苷（ARA-C）和柔红霉素（DNR），ALL用长春新碱（VCR）、DNR和泼尼松（PDN），APML用全反式维甲酸（ATRA）和DNR]，阿霉素剂量至少为30mg/sqm。尽管使用了促红细胞生成素，所有患者在诱导化疗后均出现严重贫血。ALL和AML患者血红蛋白最低点中位数分别为4.5g/dL（范围1.3 - 6.9）和5.1g/dL（范围2.6 - 6.8）。所有患者血小板最低点中位数为14.5×10⁹/L（范围1 - 24）。1例患者在诱导期可能因出血死亡。5例ALL患者中有4例达到完全缓解（CR）（包括bcr/abl病例），而AML患者中只有APML患者达到CR。3例患者（APML = 1例，ALL = 2例）仍存活且无疾病。这一小系列成年白血病患者说明了治疗耶和华见证会信徒患者的困难，但尽管如此，有力地反驳了导致这些患者逃避治疗的偏见性决定。
