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

Abstract

Previous studies have suggested that peripheral blood stem cell (PBC) transplantation has an advantage over autologous bone marrow transplantation. 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. Multicenter, randomized, controlled clinical trial. French Federation of Cancer Centers, located in cancer facilities or public hospitals with transplantation units. Children and adults with solid tumors or lymphomas who were candidates for high-dose chemotherapy. Bone marrow or filgrastim-mobilized PBCs. 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. 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. 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.