COLONY-STIMULATING FACTORS AND PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION - BENEFITS AND COSTS

High dosage chemo- or radiotherapy followed by the administration of a utologous bone marrow-derived stem cells [i.e. autologous bone marrow transplantation (ABMT)] is an established protocol for treating acute myeloid leukaemia and malignant lymphoma. The approach is also under i nvestigation in the treatment of acute lymphocytic leukaemia, multiple myeloma and solid tumours. In all of these diseases, the optimisation of indications, conditioning schemes, stem cell harvest techniques an d supportive care with growth factors is subject to continuous preclin ical research and clinical phase II and III studies. Recently, the adm inistration of peripheral blood stem cell preparations to cancer patie nts as rescue therapy after high dosage antitumour therapy has been re ceived with much enthusiasm. At first glance, the technique looks rath er easy to perform. The faster recovery of haemopoiesis, compared with ABMT, leads to shorter durations of hospitalisation. Moreover, in mos t studies, peripheral blood progenitor cell transplantation (PBPCT) re sulted in fewer septic episodes, fewer intensive care admissions, fewe r red blood cell and platelet transfusions, reduced use of anti-infect ives and parenteral nutrition, and reduced hospital costs compared wit h ABMT. The overall conclusion is that the treatment costs of PBPCT ar e 15 to 30% fewer than the treatment costs of ABMT. However, a formal comparison between PBPCT and ABMT, assessing the differences in toxici ty, costs and quality of life, is still awaited.