Colony-stimulating factors and peripheral blood progenitor cell transplantation. Benefits and costs.
High dosage chemo- or radiotherapy followed by the administration of autologous bone marrow-derived stem cells [i.e. autologous bone marrow transplantation (ABMT)] is an established protocol for treating acute myeloid leukaemia and malignant lymphoma. The approach is also under investigation in the treatment of acute lymphocytic leukaemia, multiple myeloma and solid tumours. In all of these diseases, the optimisation of indications, conditioning schemes, stem cell harvest techniques and supportive care with growth factors is subject to continuous preclinical research and clinical phase II and III studies. Recently, the administration of peripheral blood stem cell preparations to cancer patients as rescue therapy after high dosage antitumour therapy has been received with much enthusiasm. At first glance, the technique looks rather easy to perform. The faster recovery of haemopoiesis, compared with ABMT, leads to shorter durations of hospitalisation. Moreover, in most studies, peripheral blood progenitor cell transplantation (PBPCT) resulted in fewer septic episodes, fewer intensive care admissions, fewer red blood cell and platelet transfusions, reduced use of anti-infectives and parenteral nutrition, and reduced hospital costs compared with ABMT. The overall conclusion is that the treatment costs of PBPCT are 15 to 30% lower than the treatment costs of ABMT. However, a formal comparison between PBPCT and ABMT, assessing the differences in toxicity, costs and quality of life, is still awaited.
Uyl-de Groot
C A
CA
Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands.
Huijgens
P C
PC
Rutten
F F
FF
D016026:Bone Marrow Transplantation / Q000191:economics; D003115:Colony-Stimulating Factors / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D006801:Humans; D011788:Quality of Life