PERIPHERAL-BLOOD STEM-CELL AND BONE-MARROW TRANSPLANTATION FOR SOLID TUMORS AND LYMPHOMAS - HEMATOLOGIC RECOVERY AND COSTS - A RANDOMIZED, CONTROLLED TRIAL

Background: Previous studies have suggested that peripheral blood stem cell (PBSC) transplantation has an advantage over autologous bone mar row transplantation. Objective: To compare the hematologic recovery an d costs associated with PBSC transplantation with those associated wit h autologous bone marrow transplantation in patients receiving high-do se chemotherapy for solid tumors or lymphomas. Design: Multicenter, ra ndomized, controlled clinical trial. Setting: French Federation of Can cer Centers, located in cancer facilities or public hospitals with tra nsplantation units. Patients: Children and adults with solid tumors or lymphomas who were candidates for high-dose chemotherapy. Interventio ns: Bone marrow or filgrastim-mobilized PBSCs. Measurement: The major end point was the duration of thrombocytopenia (platelet count < 50 x 10(9)/L). An economic evaluation of both types of transplantation was done prospectively to measure costs and cost-effectiveness. Results: 1 29 patients entered the trial; 64 had PBSC transplantation, and 65 had bone marrow transplantation. The median duration of thrombocytopenia was 16 days in the PBSC group and 36 days in the bone marrow group (P < 0.001). All of the other clinical end points studied (time to last p latelet transfusion, duration of granulocytopenia, number of transfusi on episodes, and duration of hospitalization) favored PBSC transplanta tion. A cost analysis showed that total cost was decreased by 17% in a dults and 29% in children with PBSC transplantation; thus, PBSC transp lantation was clearly more cost-effective than bone marrow transplanta tion for both platelet and granulocyte recovery. Conclusion: Transplan tation of PBSCs is associated with more rapid hematologic recovery tha n is bone marrow transplantation after high-dose chemotherapy for soli d tumors or lymphomas. Furthermore, global costs are lower and cost-ef fectiveness ratios are better with PBSC transplantation.