Altaf Rida, Thalji Mousa, Crowder Sarah, Turner Kiera Brigh, Hassanein Hatem, Carlan Stephen
Department of Internal Medicine, Orlando Regional Healthcare System, Orlando, FL, USA.
Department of Hematology and Medical Oncology, Orlando Regional Healthcare System, Orlando, FL, USA.
Am J Case Rep. 2025 Aug 7;26:e949145. doi: 10.12659/AJCR.949145.
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.
背景 急性髓系白血病（AML）是一种罕见的侵袭性疾病，需要长期治疗。它占美国所有确诊白血病的三分之一。骨髓活检并伴有组织学、细胞遗传学和分子分析对于恶性肿瘤的分类至关重要。耶和华见证会成员坚决拒绝接受血液制品，这显著增加了化疗方案选择的复杂性。血细胞减少是AML标准化疗方案已知的不良反应。据报道，对治疗方案进行了一些调整以降低脆弱AML患者（包括拒绝输血的患者）的骨髓毒性。病例报告 一名28岁晚期的耶和华见证会女性因不良风险AML入院，初始血红蛋白水平为6.7 g/dL。住院化疗包括阿扎胞苷和维奈克拉。治疗后骨髓检查显示第28天残留白血病，原始细胞占10 - 15%。第19天，她的血红蛋白水平降至最低点3.7 g/dL。她所有的会诊和护理都是通过社区医院网络进行的。最终，她完成了3个疗程的阿扎胞苷门诊单药治疗，但选择拒绝进一步治疗，在家中去世。结论 拒绝同意使用血液制品显著增加了AML化疗方案设计的复杂性，尤其是在治疗开始时血红蛋白水平已经极低的情况下。为了实现最大临床疗效同时最小化潜在不良反应，可能需要采用替代的非标签方案定制治疗方案。基于基因的方法，包括分子靶向治疗，需要进一步研究。
