Safety of bloodless autologous stem cell transplantation in Jehovah's Witness patients.

Due to the curative potential and improvement in progression-free survival (PFS), high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is considered the standard of care for several hematologic malignancies, such as multiple myeloma, and lymphomas. ASCT typically involves support with blood product transfusion. Thus, difficulties arise when Jehovah's Witness patients refuse blood transfusions. In order to demonstrate the safety of performing "bloodless" ASCT (BL-ASCT), we performed a retrospective analysis of 66 Jehovah's Witnesses patients who underwent BL-ASCT and 1114 non-Jehovah's Witness patients who underwent transfusion-supported ASCT (TF-ASCT) at Cedars-Sinai Medical Center between January 2000 and September 2018. Survival was compared between the two groups. Transplant-related complications, mortality, engraftment time, length of hospital stay, and number of ICU transfers were characterized for the BL-ASCT group. One year survival was found to be 87.9% for both groups (P = 0.92). In the BL-ASCT group, there was one death prior to the 30 days post transplant due to CNS hemorrhage, and one death prior to 100 days due to sepsis. Based on our data, BL-ASCT can be safely performed with appropriate supportive measures, and we encourage community oncologists to promptly refer JW patients for transplant evaluation when ASCT is indicated.

CYR61: a new measure of lung cancer outcome.

Cysteine-rich protein 61 (Cyr61) is a member of a family of growth factor-inducible, immediate-early genes. In this report, the authors measured the expression of Cyr61 mRNA in 94 human lung tumors and their normal matched lung samples. The Cyr61 mRNA levels were quantified by real time reverse transcriptase-polymerase chain reaction and calculated as a tumor/normal Cyr61 mRNA ratio in each case. Compared with normal matched lung tissues, expression of Cyr61 was decreased in 74 of 94 (79 percent) lung tumors. Differences in distribution of patient characteristics, such as gender, age, tumor size, and pathological diagnosis, between high or low Cyr61 expressing groups were not statistically significant. However, differences in distribution of clinical stage between high or low Cyr61 expressing groups was statistically significant; that is, the Cyr61 low expressor group was clinically more advanced than the Cyr61 high expressor group (p = 0.046). Furthermore, Cyr61 levels of the patients with N0 and N1 diseases were significantly higher than the expression in the N2 patients (p = 0.047). The 3-year survival between the Cyr61 very low tumor expressor group compared to matched normal lung (39 patients) and the higher Cyr61 expressor group (52 patients) was statistically significant (59 versus 91 percent; p = 0.05). Taken together, Cyr61 appears to guard against metastatic disease because low expression is associated with more advanced disease; and therefore, expression levels of Cyr61 correlate with the prognosis of lung cancer.