High-dose chemotherapy (HDCT) followed by autologous peripheral blood stem cell transplantation (APBSCT) is the standard treatment for multiple myeloma and relapsed or high-risk lymphomas. To avoid bleeding complications and to treat profound anemia posttransplant, as a rule, patients are given transfusions after APBSCT. But Jehovah's Witnesses decline transfusions based on religious convictions, making the treatment of these patients' hematologic malignancies a special challenge. The authors of this report describe a transfusion-free APBSCT protocol with acceptable morbidity and mortality used on 48 Jehovah's Witnesses. Infectious complications due to transfusion are avoided; anemia is managed mainly with prophylactic erythropoierin, IV iron therapy, and volume support; and thrombocytopenia is managed solely with the use of hemostatic agents, vitamin K, and oprelvekin. Only 1 of the 48 patients died because a transfusion was withheld, and only 1 had a major bleed, which resolved upon administration of cryoprecipitate. The experiences gained in treating this patient population suggest that HDCT and APBSCT can be safely performed without the use of blood products.
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