Research and Quality Medicine in the Community: The Paradigm of Marrow Transplantation.
INTRODUCTION: Bone marrow transplantation (BMT), including the use of peripheral blood progenitor cells (PBPC), is a promising new technology for cancer treatment. BMT is defined here as the use of hematopoietic progenitor cells to support intensive cancer treatment. When obtained from the peripheral blood, these cells are called PBPC. Randomized trials suggest superiority of autologous BMT compared to conventional chemotherapy for patients with relapsed, responsive intermediate grade lymphoma or responding myeloma. Large phase II studies suggest benefit for selected patients with metastatic and primary breast cancer. These and additional data suggest an emerging role for BMT in cancer treatment. Counterbalancing these encouraging data, however, are the high cost and morbidity of BMT treatments. Rapid changes in technology also make it likely that major alterations in treatment delivery and cost improvements will occur within the next few years. How should society decide when this and other expensive and risky high-technology treatment should be performed in the community? The critical concepts which underlie this decision are quality and research.
Jones
RB
University of Colorado Health Sciences Center, Bone Marrow Transplant Program, Denver, Colorado, 80262, USA.bmtucu@entente.uhcolorado.edu