Hematopoietic stem cell transplantation without the use of blood components by the patients choice– experience of two Brazilian centers

Abstract Hematopoietic stem cell transplantation (HSCT) has been used to treat many malignant and nonmalignant hematological conditions. However, the use of HSCT in patients who refuse blood transfusions has rarely been described in the literature, and no previous data have been published concerning haploidentical transplants without blood products. The aim of this study is to describe the experience of a Brazilian group in performing 21 HSCTs without the use of blood components in the first 100 days after transplantation, which is the time period corresponding to the greatest risk of toxicity for this procedure. We developed 21 transplants without transfusion support in 19 patients admitted to two Brazilian transplant centers. The patients were subjected to stem cell mobilization and different conditioning regimens. No mortality related to the procedure was found among the transplant recipients. The global survival rate after 100 days, which is the period related to the immediate toxicity of HSCT, was 94.7%, and the median follow-up was 980 days, with an overall survival rate of 68.4%. Thus, refusal of blood transfusion is not an absolute contraindication for HSCT. This therapy is feasible in specific situations when the patient clearly expresses a desire to refuse blood transfusions, and favorable clinical conditions are achievable with strict, specialized medical monitoring.