Long-term continuous complete remission of acute myeloid leukemia in a Jehovah's witness treated without blood support

Abstract

We report the case of a young female patient, a Jehovah's witness, affected by peroxidase-positive acute leukemia. The patient, completely aware of the risks both of the disease and of the usual treatment for acute myeloid leukemia, refused any transfusional support. An atypical treatment plan with low hematological toxicity but also with reduced probability of positive results was therefore proposed and accepted. Initial treatment with vincristine and prednisone induced remission; therapy was then continued for 32 months with monthly cycles of aracytin and 6-thioguanine, at accurately tailored dosages to avoid excessive hematological toxicity. The patient never needed blood support and never suffered infectious or hemorrhagic events. She is still in remission, 11 years off-therapy. The ethical and legal aspects of treatment decisions in such situations are discussed. In the author's opinion, neither withholding all treatment nor insisting on standard measures is correct: on the contrary, as always, treatment in such cases must be tailored on the patient's needs, which include not only his physical condition but his religious beliefs as well.