title: Low cost autologous peripheral blood stem cell transplantation performed in a municipal hospital for a patient with plasma cell leukaemia.
abstract: Autologous peripheral blood stem cell transplantation (PBSCT) is a costly procedure. In India, the cost varies from US$20000 to 25000 and most patients cannot afford it. Using several cost-cutting measures, we were able to treat a patient with plasma cell leukaemia by autologous PBSCT. A 42-year-old-male presented with plasma cell leukaemia. He was treated with VAD therapy, followed by high-dose cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) for mobilization of peripheral blood stem cells. The patient was conditioned with high dose melphalan, followed by autologous PBSCT. The procedure was performed in a municipal hospital in which there was no prior experience with stem cell transplantation. Costs were reduced by: (i) using oral medication whenever possible; (ii) having a relative of the patient prepare his food under medical guidance; (iii) starting G-CSF on day 7 rather than on day 1; (iv) short-term storage of the PBSC in an ordinary refrigerator at 4 degrees C without cryopreservation; (v) infusing a large number of CD34+ cells, which shortened the time to engraftment; (vi) delegating many of the functions of a marrow transplant nurse to a resident physician. The cost of transplantation was thereby reduced to about US$ 6000, with successful engraftment by day +13. The patient remained in remission for 7 months, after which he relapsed and was treated with chemotherapy and electron beam radiation to the skin.
authors.affiliation: Institute of Immunohaematology, Indian Council of Medical Research, KEM Hospital Campus, Parel, Mumbai, India. kanjakshaghosh@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Ghosh
authors.forename: S
authors.initials: S
authors.lastname: Gosavi
authors.forename: A
authors.initials: A
authors.lastname: Pathare
authors.forename: M
authors.initials: M
authors.lastname: Madkaikar
authors.forename: V B
authors.initials: VB
authors.lastname: Rao
authors.forename: D
authors.initials: D
authors.lastname: Mohanty
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D006773:Hospitals, Municipal / Q000191:economics; D006801:Humans; D007194:India; D007952:Leukemia, Plasma Cell / Q000191:economics / Q000628:therapy*; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D012074:Remission Induction / Q000379:methods; D014182:Transplantation, Autologous / Q000191:economics