# Faith, Cancer, and Compromise: Managing Acute Myeloid Leukemia and Metastatic Triple-Negative Breast Cancer in a Jehovah's Witness Patient

## TL;DR

This paper discusses the challenges of treating a Jehovah's Witness patient with two aggressive cancers while respecting her refusal of blood transfusions.

## Contribution

The paper presents the first reported case of a Jehovah's Witness patient with concurrent AML and metastatic triple-negative breast cancer.

## Key findings

- The patient's decision to forgo treatment highlights the ethical complexities of managing cytopenias in AML without blood transfusions.
- Elderly patients with AML face significant unmet needs, especially when combined with other aggressive cancers.
- Supportive care strategies for AML patients who refuse transfusions remain underexplored in the literature.

## Abstract

The treatment of acute myelogenous leukemia (AML) is accompanied by several potentially life-threatening adverse effects, the most prevalent of which are cytopenias (anemia, thrombocytopenia, and neutropenia). As such, therapy selection is extremely challenging in patients who cannot tolerate blood transfusions or are unable due to religious convictions, such as those who practice as Jehovah's Witnesses. Additionally, the existence of another primary aggressive neoplasm further narrows the scope of therapeutic options. Here, we present the first reported case of an elderly 72-year-old woman who practices as a Jehovah's Witness, concurrently diagnosed with AML and metastatic triple-negative breast cancer. We reviewed her clinical course, management, and ultimate decision to forgo treatment due to religious beliefs. Treatment of AML in the elderly, notwithstanding transfusion status, is an unmet growing need. Here, we discuss the ethical considerations of cytopenia management in patients undergoing AML treatment and delve into the literature surrounding supportive care in such patients.