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Peripheral Blood Stem Cell and Bone Marrow Transplantation for Solid Tumors and Lymphomas: Hematologic Recovery and Costs: A Randomized, Controlled Trial

Olivier Hartmann, MD; Anne Gaelle Le Corroller, PhD; Didier Blaise, MD; Jean Michon, MD; Irene Philip, MD; Francoise Norol, MD; Maud Janvier, MD; Jose Louis Pico, MD; Marie Christine Baranzelli, MD; Herve Rubie, MD; Carole Coze, MD; Antonella Pinna; Valerie Meresse, MD; and Ellen Benhamou, MD
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For author affiliations and current author addresses, see end of text. Acknowledgments: The authors thank the Federation Nationale des Centres de Lutte Contre le Cancer for promoting this study and Lorna Saint Ange for linguistic revision of the manuscript. Grant Support: In part by the Laboratoire AMGEN France. Requests for Reprints: Olivier Hartmann, MD, Institut Gustave-Roussy, Rue Camille Desmoulins, 94 800 Villejuif, France. Current Author Addresses: Dr. Hartmann: Institut Gustave-Roussy, Rue Camille Desmoulins, 94 800 Villejuif, France.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;126(8):600-607. doi:10.7326/0003-4819-126-8-199704150-00002
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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.


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Figure 1.
Actuarial rates. Top.9PBottom.9P

Actuarial rate of patients having recovered a granulocyte count of more than 0.5 × 10 /L in the group receiving peripheral blood stem cell (PBC) transplantation and the group receiving bone marrow (BM) transplantation (log-rank test, < 0.001). Actuarial rate of patients having recovered a platelet count of more than 50 × 10 /L in the PBC group and the bone marrow group (log-rank test, < 0.001).

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Figure 2.
Event-free survival rate in the groups having peripheral blood stem cell (PBC) transplantation and bone marrow (BM) transplantation (log-rank test, P > 0.

2). Median follow-up was 20 months (range, 11 to 31 months).

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