Clinical and economic analysis of allogeneic peripheral blood progenitor cell transplants: a Canadian perspective

Allogeneic peripheral blood progenitor cell (PBPC) transplants are an alter native to BMT, although G-CSF mobilization dose, timing of pheresis and ris k of GVHD are not well defined. We compared harvest characteristics, donor and recipient outcomes and costs of two PBPC transplant strategies with his torical controls who received BMT, Twenty donors mobilized with four daily s,c, G-CSF doses (5 mu g/kg/day) (group 1) and 20 mobilized with 10 mu g/kg /day G-CSF (group 2) were compared with 20 BM controls (group 3), G-CSF and phereses were well tolerated. Four of 40 PBPC donors required femoral cath eter placement. At least 2.5 x 10(6) CD34(+)/kg recipient weight were colle cted with two phereses in 19/20 donors (group 1) and 18/20 donors (group 2) , Time to neutrophil (18 vs 20 vs 22 days, P = 0.02) and platelet (21 vs 24 vs 27 days, P = 0.005) engraftment was shorter in the PBPC groups (group 2 vs group 1 vs group 3) but secondary engraftment outcomes were not differe nt. The incidence of grade 2-4 aGVHD was higher in the low-dose G-CSF group (group 1) but there was no difference in cGVHD, 100-day or 1-year survival . The mean PBPC transplant cost (group 1) at first hospital discharge was l ess than BM (group 3) ($34 643 vs $37 354) but the mean overall cost for bo th groups was similar at 100 days ($46 334 vs $46 083), Allogeneic PBPC tra nsplant with short course, low-dose G-CSF mobilization is safe, feasible an d cost equivalent to allogeneic BMT.