Peripheral Blood Stem Cell and Bone Marrow Transplantation for Solid Tumors and Lymphomas: Hematologic Recovery and Costs: A Randomized, Controlled Trial

  1. Olivier Hartmann, MD;
  2. Anne Gaelle Le Corroller, PhD;
  3. Didier Blaise, MD;
  4. Jean Michon, MD;
  5. Irene Philip, MD;
  6. Francoise Norol, MD;
  7. Maud Janvier, MD;
  8. Jose Louis Pico, MD;
  9. Marie Christine Baranzelli, MD;
  10. Herve Rubie, MD;
  11. Carole Coze, MD;
  12. Antonella Pinna;
  13. Valerie Meresse, MD; and
  14. Ellen Benhamou, MD
  1. For author affiliations and current author addresses, see end of text. Acknowledgments: The authors thank the Federation Nationale des Centres de Lutte Contre le Cancer for promoting this study and Lorna Saint Ange for linguistic revision of the manuscript. Grant Support: In part by the Laboratoire AMGEN France. Requests for Reprints: Olivier Hartmann, MD, Institut Gustave-Roussy, Rue Camille Desmoulins, 94 800 Villejuif, France. Current Author Addresses: Dr. Hartmann: Institut Gustave-Roussy, Rue Camille Desmoulins, 94 800 Villejuif, France.

    Abstract

    Background: Previous studies have suggested that peripheral blood stem cell (PBC) transplantation has an advantage over autologous bone marrow transplantation.

    Objective: To compare the hematologic recovery and costs associated with PBC transplantation with those associated with autologous bone marrow transplantation in patients receiving high-dose chemotherapy for solid tumors or lymphomas.

    Design: Multicenter, randomized, controlled clinical trial.

    Setting: French Federation of Cancer Centers, located in cancer facilities or public hospitals with transplantation units.

    Patients: Children and adults with solid tumors or lymphomas who were candidates for high-dose chemotherapy.

    Interventions: Bone marrow or filgrastim-mobilized PBCs.

    Measurement: The major end point was the duration of thrombocytopenia (platelet count < 50 × 109/L). An economic evaluation of both types of transplantation was done prospectively to measure costs and cost-effectiveness.

    Results: 129 patients entered the trial; 64 had PBC transplantation, and 65 had bone marrow transplantation. The median duration of thrombocytopenia was 16 days in the PBC group and 36 days in the bone marrow group (P < 0.001). All of the other clinical end points studied (time to last platelet transfusion, duration of granulocytopenia, number of transfusion episodes, and duration of hospitalization) favored PBC transplantation. A cost analysis showed that total cost was decreased by 17% in adults and 29% in children with PBC transplantation; thus, PBC transplantation was clearly more cost-effective than bone marrow transplantation for both platelet and granulocyte recovery.

    Conclusion: Transplantation of PBCs is associated with more rapid hematologic recovery than is bone marrow transplantation after high-dose chemotherapy for solid tumors or lymphomas. Furthermore, global costs are lower and cost-effectiveness ratios are better with PBC transplantation.

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    1. Ann Intern Med April 15, 1997 vol. 126 no. 8 600-607
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