LEUKINE has been FDA approved for use in multiple indications: For use following induction chemotherapy in older adults with Acute Myelogenous Leukemia (AML)
For use in myeloid reconstitution after autologous bone marrow transplantation
For use in myeloid reconstitution after allogeneic bone marrow transplantation
For use in transplantation (BMT) failure or engraftment delay
For use in mobilization and following transplantation of autologous peripheral blood progenitor cells.

It is guideline (NCCN, ASCO) recommended for preventing and treatment of febrile neutropenia. ALthough it is an unusual choice (usually Neupogen or Neulasta would have been used), it remains a guideline recommended treatment and, therefore, medically necessary.

On 1/24 Bayer and FDA informed healthcare professionals of the market withdrawal of the current liquid formulation of Leukine, a growth factor that helps fight infection and disease in appropriate patients by enhancing immune cell function. The product was withdrawn because of an upward trend in spontaneous reports of adverse reactions, including syncope (fainting), which are temporally correlated with a change in the formulation of liquid Leukine to include edetate disodium (EDTA). The upward trend in adverse reaction reporting rates has not been observed with the use of lyophilized Leukine. Healthcare professionals should immediately stop using liquid Leukine and return unused vials to the manufacturer.

http://www.fda.gov/medwAtch/safety/2008/Leukine_DHCP_01-23-2008.pdf

nccn.org, neutropenia

With an estimated 6000000 Jehovah’s witnesses worldwide, haematologists may encounter patients who decline blood transfusions as a matter of personal belief.The risks of high-dose chemotherapy include life threatening bleeding from thrombocytopenia and profound anemia. Autologous stem cell transplantation is usually associated with the transfusion of 5 to 20 units of red blood cell or platelets, with the potential side-effects of infectious disease transmission, transfusion reactions, and iron overload. Inabilty ot ransfuse can be accommodates by increasing use of erythropoietin (although this was shown in one study not to change outcomes), minimizing blood collection and blood sparing techniques.

In recent years, several facilites, such as University of Pennsylvania,  have extended their bloodles surgery programs into the area of transplantation. However, this remains supported by case reports abd series only. It might be expected that only successful cases are published since a publication bias applies in this situation. It is also likely that some conditions are less suitable to this approach and this, as well as apropriate patietn selection,  must be explored in clinical trials.

K K Ballen et al,  Case Report  Successful autologous bone marrow transplant without the use of blood product support July 2000, Volume 26, Number 2, Pages 227-229

Estrin JT, Ford PA, Henry DH et al. Erythropoietin permits high-dose chemotherapy with peripheral blood stem-cell transplant for a Jehovah’s Witness. Am J Hematol 1997; 55: 51-52

Bone Marrow Transplant. 2008 Feb 4 [Epub ahead of print] Links
SCT in Jehovah’s Witnesses: the bloodless transplant.Sloan JM, Ballen K..

Diagnosis and treatmetn of head and neck cancer is complex and requires co-ordination or providers and resources. Delays in diagnosis is not uncommon. In a Canadian study, median patient, professional and total delays were 4.5 weeks, 11.8 weeks and 22.5 weeks, respectively. Significantly longer delays were found among women(p < 0.01), non-smokers (p < 0.01), patients who were not referred following initial consultation(p < 0.001) and patients who did not visit their dentist (p < 0.05). Delays in diagnosis was a major factor in malparctice litigation in the USA. A 2005 study found that the median delay was 3 months and the patients were responsible for the delay in most cases (n = 319, 81% and n = 160, 78%, respectively). Half the patients in each studies cohort had delayed diagnoses (n = 217, 54% and n = 119, 56%, respectively) and similar percentages (n = 110, 53% and n = 172, 47%) presented with advanced disease (stage III or IV). These were not the same patients for there was no correlation between delay and stage or survival. AN article in the New York Times Health Guide says that “Approximately 25% of people with oral cancer die because of delayed diagnosis and treatment.”(http://health.nytimes.com/health/guides/disease/oral-cancer/overview.html). However, the literature, particularly several studies from Finland, are contradictory in this regard.

Yu T, Wood RE, Tenenbaum HC. Delays in diagnosis of head and neck cancers.J Can Dent Assoc. 2008 Feb;74(1):61

Goy J, Hall SF, Feldman-Stewart D, Groome PA. Diagnostic delay and disease stage in head and neck cancer: a systematic review. Laryngoscope. 2009 May;119(5):889-98.

http://robotics.me.jhu.edu/~rothbaum/Articles%20to%20read/Medical%20malpractice%20and%20head%20and%20neck%20cancer.pdf

Alho, O.-P., Teppo, H., Mantyselka, P., Kantola, S. (2006). Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases.. CMAJ 174: 779-784

Teppo H, Koivunen P, Hyrynkangas K, et al. Diagnostic delays in laryngeal carcinoma: professional diagnostic delay is a strong independent predictor of survival. Head Neck 2003;25:389-94

Koivunen P, Rantala N, Hyrynkangas K, Jokinen K, Alho OP.
The impact of patient and professional diagnostic delays on survival in pharyngeal cancer.Cancer. 2001 Dec 1;92(11):2885-91.