COST-BENEFIT OF GRANULOCYTE-COLONY-STIMULATING FACTOR ADMINISTRATION IN OLDER PATIENTS WITH NON-HODGKINS-LYMPHOMA TREATED WITH COMBINATION CHEMOTHERAPY

Background: Older patients with non-Hodgkin's lymphoma (NHL) display a poorer response to chemotherapy and a significantly higher treatment- associated toxicity than do younger individuals. We investigated the p otential clinical benefits and the cost-effectiveness of accelerated g ranulocyte recovery induced by recombinant granulocyte colony-stimulat ing factor (G-CSF) in patients with aggressive NHLs, aged 60-70 years, during treatment with a second-generation combination chemotherapy. P atients and methods: 12 consecutive patients (median age 66 years) tre ated with six to eight courses of CHVmP/VB plus subcutaneous G-CSF (5 mug/kg/day) were compared with 11 consecutive subjects (median age 65 years) who received the same chemotherapy regimen without growth facto r support. The two groups of patients were fully comparable as to the clinicopathologic features. A comparative analysis of treatment costs (including hospitalization, antimicrobial prophylaxis and therapy, sup portive and diagnostic procedures, and G-CSF) was also performed. Resu lts: Both the overall response rate and the percentage of complete rem issions were comparable in the two treatment groups. In the control gr oup, 32.5% of chemotherapy courses were delayed, as opposed to 19% in the G-CSF group (p = 0.05). The mean duration of delay for patients re ceiving or not receiving G-CSF was 10.1 and 25.9 days, respectively (p - 0.02). Grade 3 and 4 granulocytopenia complicated 27.7% of chemothe rapy courses in control patients and only 4.8% in subjects receiving G -CSF (p < 0.001). Similarly, severe infections and mucositis were sign ificantly higher in patients receiving chemotherapy alone (15.6% and 3 .6%, respectively) compared to the G-CSF group (4.8%, p = 0.01; p = 0. 04, respectively). A mean of 1.1 days/course of hospitalization was re quired in the control group, as opposed to 0.2 days/course in patients receiving G-CSF (p - 0.05). Although overall treatment costs were hig her in the control group, single cost of the recombinant growth factor exceeded by far all the other expenses in the G-CSF group, reaching a statistical relevance (p - 0.01). Conclusions: The inclusion of proph ylactic G-CSF in the treatment plan for aggressive NHL in older patien ts appears safe and cost-effective in view of the peculiar clinical fe atures of aged subjects and the possibility of delivering effective do ses of antineoplastic drugs on an outpatient setting.