림프종과 다발골수종이 진단된 여호와의 증인 환자들의 무수혈 항암 치료 성적
Bloodless Treatment of Jehovah’s Witness Patients with Lymphoma and Multiple Myeloma
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목적: 여호와의 증인 신도들은 종교적인 이유로 수혈을거부한다. 순천향대학교 서울병원은 2000년도부터 무수혈센터를 운영하고 있어서 무수혈 치료를 원하는 여호와의 증인환자들의 데이터베이스가 구축되어 있다. 따라서 저자들은순천향대학교 서울병원에 입원하여 무수혈로 치료받았던 혈액암 환자들 중 림프종 및 다발골수종 환자의 치료 성적을분석하고자 하였다. 방법: 2006년부터 2021년까지 순천향대학교 서울병원에서 림프종 혹은 다발골수종을 진단받고 무수혈 항암 치료를시행한 환자들을 대상으로 후향적으로 자료를 분석하였다. 결과: 림프종 환자의 2년 생존율은 66.6%였고, 진단 후6개월 미만에 사망한 환자들은 전체 림프종 환자의 22.7%였다. 이와 같이 조기 사망한 환자들의 혈색소 수치 평균값은5.5 g/L, 혈소판 수치 평균값은 50,142/μL였으며, 임종기에 빈혈 및 혈소판 감소의 심화로 인해 환자들이 호소했던 증상중에서는 빈혈로 인한 호흡곤란이 가장 빈번하였다. 다발골수종은 환자의 중앙 생존값은 60.3개월, 1년 생존율은 57.1% 였다. 총 7명의 환자 중 3명이 자가조혈모세포 이식 가능한연령이었음에도 불구하고 무수혈의 제한점 때문에 항암 치료 단독으로 치료하였으며, 71.4%에서 무수혈로 인해 치료약제의 종류와 강도를 조절하였다. 결론: 치료 시작부터 무수혈을 고려하여 치료 강도를 낮추면서 이로 인해 치료 반응에 영향을 주었을 것으로 예상되는 사례들이 있기는 하였지만 상당수의 림프종, 다발골수종환자에서는 무수혈 치료로 표준 항암 치료 완료와 장기 생존이 가능하였다.
Abstract
Background/Aims: Jehovah’s Witnesses refuse blood transfusions for religious reasons. Soonchunhyang University Hospital Seoul has operated a bloodless treatment center since 2000, and a database of bloodless treatment patients has been created. This study aimed to analyze the bloodless treatment outcomes of lymphoma and multiple myeloma patients. Methods: We retrospectively analyzed data of patients diagnosed with lymphoma (22 patients) or multiple myeloma (seven patients) who were treated bloodlessly at Soonchunhyang University Hospital Seoul from 2006 to 2021. Results: The 2-year survival rate for lymphoma patients was 66.6%, with 22.7% dying within 6 months of diagnosis. Those who died early (within 6 months) had a median hemoglobin level of 5.5 g/dL and a median platelet count of 50,142/μL. Dyspnea due to anemia was the most common symptom reported by patients at the end of life. Patients with multiple myeloma had a median survival of 60.3 months and a 2-year survival rate of 57.1%. Although three of the seven multiple myeloma patients were eligible for autologous stem cell transplantation, they were treated with chemotherapy only due to limitations of the bloodless treatment. The drug type and intensity were adjusted due to hematological toxicities in 71.4% of multiple myeloma patients. Conclusions: A significant proportion of patients completed their planned course of chemotherapy and achieved long-term survival. The treatments of some patients were adjusted due to the use of bloodless treatment at the initial chemotherapy session, which affected their response to treatment.
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