MacNeill Michael, Fulford Adrienne, Caldwell Deanna, Deotare Uday
Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada.
Hematol Transfus Cell Ther. 2025 Jul-Sep;47(3):103958. doi: 10.1016/j.htct.2025.103958. Epub 2025 Jul 30.
Hematopoietic stem cell transplantation (HSCT) is an important part of treatment for many hematologic conditions. The high-dose chemotherapy used in HSCTs puts patients at risk of significant cytopenias which often necessitate blood product transfusions. Certain populations, including Jehovah's Witnesses, are unable to receive blood product transfusions during their transplant and thus, in the past, they have been seen as unsuitable candidates for transplantations. However, there has been growing evidence of the safety and efficacy of so-called "bloodless" HSCT protocols.
The most recent and relevant literature on "bloodless" transplants were identified through Embase, MEDLINE, and PubMed, and analyzed to construct a "bloodless" HSCT protocol at a Canadian centre. Since 2021, the regimen was utilized for four autologous transplantations in three different Jehovah's Witness patients.
None of the patients had a significant bleeding event nor a hemoglobin nadir below 8.0 g/dL. Minor bleeding events, predominantly mucositis, resolved with site-specific management. No patient had significant thrombocytopenia, and all the cell lines of patients had normalized without transfusions by the time of discharge. All patients were hospitalized for <30 days, similar to the experience of the centre with "regular" autologous transplants.
Careful planning and tailored regimens support the achievability of "bloodless" HSCTs in patients, such as Jehovah's Witnesses, allowing practitioners to provide care to a previously excluded group and minimize the use of blood products in all HSCT patients.
造血干细胞移植（HSCT）是许多血液疾病治疗的重要组成部分。HSCT中使用的大剂量化疗使患者面临严重血细胞减少的风险，这通常需要输血。某些人群，包括耶和华见证人，在移植期间无法接受输血，因此，过去他们被视为不适合移植的候选人。然而，越来越多的证据表明所谓的“无血”HSCT方案的安全性和有效性。
通过Embase、MEDLINE和PubMed检索有关“无血”移植的最新及相关文献，并进行分析，以在加拿大一个中心构建“无血”HSCT方案。自2021年以来，该方案用于3名不同的耶和华见证人患者的4次自体移植。
所有患者均未发生严重出血事件，血红蛋白最低点也未低于8.0 g/dL。轻微出血事件主要为粘膜炎，通过局部处理得以解决。没有患者出现严重血小板减少，所有患者的细胞系在出院时均未输血而恢复正常。所有患者住院时间均<30天，与该中心“常规”自体移植的情况相似。
精心规划和量身定制的方案有助于在耶和华见证人等患者中实现“无血”HSCT，使从业者能够为以前被排除的群体提供治疗，并尽量减少所有HSCT患者的血液制品使用。
