title: Clinical outcomes and direct hospital costs of reduced-intensity allogeneic transplantation in chronic myeloid leukemia.
abstract: A reduced-intensity conditioning allogeneic stem cell transplantation was given to 19 patients (aged 15-59 years) in the first chronic phase and one patient in the accelerated phase with chronic myeloid leukemia (CML) after a regimen consisting of fludarabine (Flu), busulfan (Bu) and ATG Fresenius. The median follow-up was 27 months. Until day +100, no transplant-related mortality was recorded. The incidence of acute and chronic graft-versus-host disease (GvHD) was 55 and 75%, respectively. Two patients (10%) died from GvHD. Fourteen (70%) patients achieved molecular remission. Additional post-transplant intervention (donor lymphocyte infusion, imatinib) was necessary, however, in 10 patients (50% of the patients; non-achievement of stable molecular remission or later relapses). The total direct cost of the transplantation treatment for all of the patients came to 1,572,880 euro. If the patients had been treated with imatinib and followed-up with the same time period as they were following a transplantation, the direct cost of the imatinib treatment would have been 2,005,117 euro. The transplantation treatment appears to be less expensive after approximately 2 years of follow-up. Flu+Bu+ATG is a low-toxicity regimen for patients with CML. However, a close follow-up is necessary and about 50% of the patients require further therapeutic intervention.
authors.affiliation: Department of Internal Medicine - Hematooncology, University Hospital Brno, Brno, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Krejci
authors.forename: J
authors.initials: J
authors.lastname: Mayer
authors.forename: M
authors.initials: M
authors.lastname: Doubek
authors.forename: Y
authors.initials: Y
authors.lastname: Brychtova
authors.forename: Z
authors.initials: Z
authors.lastname: Pospisil
authors.forename: Z
authors.initials: Z
authors.lastname: Racil
authors.forename: D
authors.initials: D
authors.lastname: Dvorakova
authors.forename: M
authors.initials: M
authors.lastname: Lengerova
authors.forename: O
authors.initials: O
authors.lastname: Horky
authors.forename: Z
authors.initials: Z
authors.lastname: Koristek
authors.forename: T
authors.initials: T
authors.lastname: Dolezal
authors.forename: J
authors.initials: J
authors.lastname: Vorlicek
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D018153:Czech Republic; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D010677:Philadelphia Chromosome; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000191:economics / Q000379:methods; D014184:Transplantation, Homologous / Q000191:economics / Q000379:methods; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine