Treatment Experience for a Child with Ewing Sarcoma who Refused to Receive Blood Transfusions for Religious Reasons as a Jehovah’s Witness

Ewing sarcoma is a solid tumor involving the bone and/or surrounding soft tissue, which requires multidisciplinary treatment, primarily through a combination of surgery and chemotherapy and, in some cases, radiation therapy. We present the case of a patient who was diagnosed with stage I Ewing sarcoma without metastasis who had a lesion in one of the left 3rd metacarpal bones. The patient’s family members were active Jehovah’s Witnesses; therefore, the patient’s guardian refused blood transfusions for religious reasons. The medical staff explained the fatal side effects of pancytopenia after chemotherapy, and when life-threatening anemia, thrombocytopenia, and neutropenia occurred, the patient’s guardian agreed that the intensity of chemotherapy needed to be either reduced or stopped. The patient’s treatment regimen was as follows: VDC (vincristine, doxorubicin, cyclophosphamide) and IE (ifosfamide, etoposide) were alternately administered as neoadjuvant chemotherapy, followed by complete tumor excision and more chemotherapy. As red blood cell transfusion was impossible, only erythropoietin (EPO; EpokineⓇ, HK inno.N, Seoul, Korea) and granulocyte colony-stimulating factor (G-CSF; GrasinⓇ, Kyowa Kirin, Seoul, Korea) were administered as adjuvant therapy. During the course of treatment, hemoglobin levels decreased to as low as 6.7 g/dL; however, treatment without transfusion was possible with the administration of EPO and G-CSF, with minimal changes in the chemotherapy schedule. With 6 months follow-up post-treatment, the patient is still alive with no relapses observed on positron emission tomography-CT and bone scans.