Background: Previous studies have suggested that peripheral blood stem cell (PBC) transplantation has an advantage over autologous bone marrow transplantation.
Objective: To compare the hematologic recovery and costs associated with PBC transplantation with those associated with autologous bone marrow transplantation in patients receiving high-dose chemotherapy for solid tumors or lymphomas.
Design: Multicenter, randomized, controlled clinical trial.
Setting: French Federation of Cancer Centers, located in cancer facilities or public hospitals with transplantation units.
Patients: Children and adults with solid tumors or lymphomas who were candidates for high-dose chemotherapy.
Interventions: Bone marrow or filgrastim-mobilized PBCs.
Measurement: The major end point was the duration of thrombocytopenia (platelet count < 50 × 109/L). An economic evaluation of both types of transplantation was done prospectively to measure costs and cost-effectiveness.
Results: 129 patients entered the trial; 64 had PBC transplantation, and 65 had bone marrow transplantation. The median duration of thrombocytopenia was 16 days in the PBC group and 36 days in the bone marrow group (P < 0.001). All of the other clinical end points studied (time to last platelet transfusion, duration of granulocytopenia, number of transfusion episodes, and duration of hospitalization) favored PBC transplantation. A cost analysis showed that total cost was decreased by 17% in adults and 29% in children with PBC transplantation; thus, PBC transplantation was clearly more cost-effective than bone marrow transplantation for both platelet and granulocyte recovery.
Conclusion: Transplantation of PBCs is associated with more rapid hematologic recovery than is bone marrow transplantation after high-dose chemotherapy for solid tumors or lymphomas. Furthermore, global costs are lower and cost-effectiveness ratios are better with PBC transplantation.