ACUTE-LEUKEMIA IN JEHOVAH-WITNESSES

The refusal of Jehovah's Witnesses with leukaemia to accept transfusio n provides a major clinical challenge because of the myelosuppressive effects of chemotherapy. Experience in treating five such patients is described. Two patients with acute lymphoblastic leukaemia (ALL) achie ved remission following chemotherapy, the first without transfusion su pport, the second, a minor, receiving transfusion under a court order: the first patient remains in remission 5 years later, whereas the sec ond subsequently relapsed and died. Of three patients with acute myelo id leukaemia (AML), two received chemotherapy: one died of anaemia dur ing induction chemotherapy whereas the second eventually consented to transfusion but died of refractory leukaemia. The third patient died o f anaemia despite erythropoietin. We feel Jehovah's Witnesses should n ot be denied antileukaemic therapy if they fully understand the risks involved. Minimizing phlebotomy, use of antifibrinolytic agents and gr owth factors may make chemotherapy feasible, especially in ALL where r emission may be induced with less myelosuppressive agents. The outlook for those with AML treated with conventional chemotherapy appears poo r; alternative approaches to treatment should be considered in these p atients.