Favorable treatment outcome in non-Hodgkin's lymphoma patients with "poor" mobilization of peripheral blood progenitor cells.
Our purpose was to evaluate the outcome and costs of high-dose chemotherapy and autologous peripheral blood progenitor cell (PBPC) transplantation in patients with the inability to mobilize sufficient numbers of PBPCs to allow rapid engraftment after PBPC transplantation. We treated 172 consecutive non-Hodgkin's lymphoma (NHL) patients with cyclophosphamide and granulocyte colony-stimulating factor followed by apheresis to collect PBPCs. The cells were separated on a Percoll gradient and purged with monoclonal antibodies and complement. The patients were categorized as "good" mobilizers if a collection of > or =2 x 10(6) CD34+ cells/kg was obtained (n = 138, 80%) or "poor" mobilizers if <2 x 10(6) CD34+ cells/kg were obtained (n = 34, 20%). With a median follow-up of 3.5 years, there is no statistically significant difference in actuarial event-free survival, overall survival, or relapse for good mobilizers compared with poor mobilizers. However, there was a trend toward increasing nonrelapse, transplantation-related mortality of 11.8% for poor mobilizers versus 3.6% for good mobilizers (P = .08) and early death from all causes including relapse within 120 days (poor 20.6% versus good 8.7%, P = .06). The total cost for bone marrow transplantation-related care was significantly higher, at $140,264 for poor mobilizers versus $80,833 for good mobilizers (P = .0001). The population of patients with NHL who mobilize PBPCs poorly into the circulation have a higher cost for posttransplant support. However, there is no significant difference in relapse, event-free survival, or overall survival for such patients compared with those who mobilize PBPCs easily.
Stockerl-Goldstein
K E
KE
Divisions of Bone Marrow Transplantation, Stanford University School of Medicine, California 94305-5623, USA. ksgold@stanford.ed
Reddy
S A
SA
Horning
S F
SF
Blume
K G
KG
Chao
N F
NF
Hu
W W
WW
Johnston
L F
LF
Long
G D
GD
Strober
S
S
Wong
R M
RM
Feiner
R H
RH
Kobler
S
S
Negrin
R S
RS
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001772:Blood Cell Count; D002140:California / Q000453:epidemiology; D002330:Carmustine / Q000008:administration & dosage; D003365:Costs and Cost Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D017048:Health Care Costs; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000401:mortality; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000191:economics / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
D005047:Etoposide; D003520:Cyclophosphamide; D002330:Carmustine