AML-104: Westchester Medical Center (WMC) Approach to Jehovah’s Witness Acute Myeloid Leukemia (AML) Patients

Objective: Development of a bloodless therapeutic approach to management of AML in Jehovah’s Witness patients Design: Our center developed an approach for bloodless management of AML in adult patients in line with the religious beliefs of Jehovah’s Witness patients. Setting: There are over 8 million Jehovah’s Witnesses worldwide. Their world headquarters is located 30 miles from WMC, and the area supports a sizable population of Jehovah’s Witnesses. Eligible Patients: Eligibility criteria include: >18 years of age, confirmed diagnosis of AML, and refusal to accept transfusion of blood products. Interventions: The protocol emphasizes the optimization of hemoglobin and platelet count, practicing conservative measures, such as minimizing blood draws and invasive procedures and using prophylactic measures against potential complications such as gastrointestinal bleeding. Our protocol includes: pediatric tubes, limited blood draws, IV iron, erythropoietin, weekly romiplostim, vitamin B12, folate, and aminocaproic acid. Venetoclax was planned for patients, given its less hematopoietic burden than traditional intensive chemotherapy. Main Outcomes Measures: The primary outcome is overall survival. Secondary outcome is progression free survival. Outcome measures include hemoglobin and platelet counts. Results: We present our first patient using this approach to evaluate efficacy and safety of this bloodless induction protocol, a 57-year-old gentleman with newly diagnosed AML. We initiated venetoclax and decitabine, along with all supportive interventions outlined above. Unfortunately, the patient felt unwell after the initial doses of chemotherapy and declined further treatment and left against medical advice. The patient’s total hospital stay was six days. We saw no qualitative, logistical, or administrative concerns with the bloodless approach. On discharge, the patient’s hemoglobin was 3.8 g/dL and his platelet count was 4 k/mm3. He eventually was admitted to another hospital, where he expired without AML treatment. We were unable to measure our primary and secondary outcomes, given our patient did not complete treatment. Conclusions: Though our initial patient did not complete his induction chemotherapy, from a qualitative analysis, our supportive care measures to optimize hemoglobin and platelet counts and limit bleeding risk were delivered without issues and may serve as a model for other centers with patients declining blood products in their leukemia care.