High-dose therapy with autologous stem-cell support has become common treatment for relapsed or refractory lymphomas.
We conducted a study of 178 patients with Hodgkin's disease and 149 patients with non-Hodgkin's lymphoma who received high-dose therapy with stem-cell support.
We evaluated the following : (1) whether improvements in outcomes over time found for surgical procedures were also true for a new nonsurgical procedure, autologous bone marrow and peripheral stem-cell transplantation ; and (2) whether such a relationship, if it existed, applied to both clinical and economic outcomes.
Mortality rates for patients with Hodgkin's disease decreased from 20% in 1987 to 0% in 1991.
For non-Hodgkin's lymphoma, the mortality rate decreased from 29% in 1987 to 4% in 1991.
Multivariate analyses indicated that the number of previous transplants was the most important factor associated with survival and low-cost care.
After controlling for differences in clinical factors, a logistic regression model predicted that patients with Hodgkin's disease had a 20% chance of dying after 30 cases and a 5% chance after 178 cases ; patients with non-Hodgkin's disease had a 33% chance of dying after 14 cases and a 5% chance after 149 cases.
For patients with Hodgkin's disease, the cost decreased at a rate of 10% per year from 1987 to 1991 (P=001), while for patients with non-Hodgkin's lymphoma, the cost of transplants decreased at a rate of 8% per year.
Mots-clés Pascal : Hodgkin maladie, Lymphome non hodgkinien, Homme, Chimiothérapie, Anticancéreux, Dose forte, Autogreffe, Cellule souche, Cellule hématopoïétique, Traitement associé, Analyse coût, Pronostic, Economie santé, Nebraska, Etats Unis, Amérique du Nord, Amérique, Hémopathie maligne, Lymphoprolifératif syndrome, Greffe
Mots-clés Pascal anglais : Hodgkin disease, Non Hodgkin lymphoma, Human, Chemotherapy, Antineoplastic agent, High dose, Autograft, Stem cell, Hematopoietic cell, Combined treatment, Cost analysis, Prognosis, Health economy, Nebraska, United States, North America, America, Malignant hemopathy, Lymphoproliferative syndrome, Graft
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0269935
Code Inist : 002B19B. Création : 01/03/1996.