Clinical and economic analysis of allogeneic peripheral blood progenitor cell transplants : a Canadian perspective.
Allogeneic peripheral blood progenitor cell (PBPC) transplants are an alternative to BMT, although G-CSF mobilization dose, timing of pheresis and risk of GVHD are not well defined.
We compared harvest characteristics, donor and recipient outcomes and costs of two PBPC transplant strategies with historical controls who received BMT.
Twenty donors mobilized with four daily s.c. G-CSF doses (5 mug/kg/day) (group 1) and 20 mobilized with 10 mug/kg/day G-CSF (group 2) were compared with 20 BM controls (group 3).
G-CSF and phereses were well tolerated.
Four of 40 PBPC donors required femoral catheter placement.
At least 2.5 x 106 CD34+/kg recipient weight were collected with two phereses in 19/20 donors (group 1) and 18/20 donors (group 2).
Time to neutrophil (18 vs 20 vs 22 days, P=0.02) and platelet (21 vs 24 vs 27 days, P=0.005) engraftment was shorter in the PBPC groups (group 2 vs group 1 vs group 3) but secondary engraftment outcomes were not different.
The incidence of grade 2-4 aGVHD was higher in the low-dose G-CSF group (group 1) but there was no difference in cGVHD, 100-day or 1-year survival.
The mean PBPC transplant cost (group 1) at first hospital discharge was less than BM (group 3) ($34 643 vs $37 354) but the mean overall cost for both groups was similar at 100 days ($46 334 vs $46 083).
Allogeneic PBPC transplant with short course, low-dose G-CSF mobilization is safe, feasible and cost equivalent to allogeneic BMT.
Mots-clés Pascal : Greffe, Homogreffe, Cellule souche, Cellule hématopoïétique, Sang, Mobilisation, Facteur stimulant colonie granulocyte, Collection, Aphérèse, Maladie greffon hôte, Aigu, Chronique, Complication, Prise greffe, Donneur, Analyse coût, Economie santé, Canada, Amérique du Nord, Amérique, Homme, Cytokine, Polypeptide, Immunopathologie
Mots-clés Pascal anglais : Graft, Homograft, Stem cell, Hematopoietic cell, Blood, Mobilization, Granulocyte colony stimulating factor, Collection, Apheresis, Graft versus host reaction, Acute, Chronic, Complication, Engraftment, Donor, Cost analysis, Health economy, Canada, North America, America, Human, Cytokine, Polypeptide, Immunopathology
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0061675
Code Inist : 002B27D02. Création : 31/05/1999.