Implementation of peripheral blood CD34 analyses to initiate leukapheresis: marked reduction in resource utilization.
BACKGROUND
Analysis of the peripheral blood (PB) C34 value may determine the optimal time to initiate leukapheresis.


METHODS
After selecting a threshold PB CD34 value of five CD34 + cells per microL to initiate leukapheresis procedure, a prospective analysis of 50 consecutive patients was initiated to identify the optimal time to initiate leukapheresis and its impact on costs and resource utilization. Clinical decisions were made to commence or to postpone leukapheresis with this PB CD34 threshold number. Based on PB CD34 values for each patient, the number of leukapheresis procedures, postponed or canceled, the number of CD34+ cells per kg, and the total number of cells collected were identified. Costs of mobilization were obtained from the hospital cost accounting system.


RESULTS
In 13 months, 50 patients with a hematologic disorder underwent mobilization. There were 34 cancellations or postponements of collections due to a low PB CD34 value in 13 patients. By use of our identified costs per initial collection, this resulted in a savings of 67,660 US dollars.


CONCLUSIONS
This prospective study defines how the implementation of the PB CD34 value results in costs savings. A low PB CD34 value canceled or postponed a significant number of leukapheresis procedures, resulting in a substantial cost savings. Use of the PB CD34 value should be the standard of care during mobilization and peripheral blood progenitor cell collection.
Bone Marrow Transplant Program, Division of Hematology and Oncology, Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH 03756, USA. Kenneth.Meehan@Hitchcock.org
Kenneth R
KR
Meehan
John M
JM
Hill
Linda
L
Patchett
Susan M
SM
Webber
Jillian
J
Wu
Pamela
P
Ely
Zbigniew M
ZM
Szczepiorkowski
D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000097:blood; D018952:Antigens, CD34 / Q000097:blood*; D003365:Costs and Cost Analysis; D005260:Female; D015276:Health Care Rationing; D006402:Hematologic Diseases / Q000097:blood / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization; D006412:Hematopoietic Stem Cells / Q000473:pathology / Q000502:physiology*; D006801:Humans; D007937:Leukapheresis / Q000191:economics / Q000379:methods*; D007938:Leukemia / Q000097:blood / Q000628:therapy; D008223:Lymphoma / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D014481:United States
D015703:Antigens, CD; D018952:Antigens, CD34