Tenorio GG, Ferrer-Argote VE, Glender-Díaz W, Collazo-Jaloma J

Language: Spanish
References: 13
Page: 16-19
PDF size: 532.62 Kb.

ABSTRACT

Introduction: Combination chemotherapy (CC) induces high remission rates in pediatric ALL (PALL) but requires intensive support with blood derivatives for the anemia and hemorrhages secondary to the ALL and the CC. Jehovah’s Witnesses (JW), who refuse blood transfusions (BT) for religions reasons, pose a therapeutic and ethical challenge and usually receive compassionate treatment with poor results. On the other hand, stimulating agents of hematopoiesis (SAH) might allow the elaboration of strategies to give CC without BT (CCWBT). Objectives: To evaluate the possibility of inducing remission of PALL associating CCWBT and SAH in JW. Materials and methods: Four children with high-risk PALL received CC (vincristine, daunorrubicin, bleomycin, L-asparaginase, prednisone, metotrexate) and SAH (erythropoietin, G-CSF, interleukin-11, iron, B12). Results: Three children achieved complete remission in 4-8 weeks and one died of anemia. Conclusions: It seems unfair to deny systematically CC to JW with PALL since it is possible to induce its remission combining CCWBT and SAH. The therapeutic strategies must be adapted to each patient. The strategies used by us can certainly be improved but they show new horizons for the treatment of hematologic malignancies using CCWBT in patients that will rather die than accept blood transfusions.

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