RECOMBINANT HUMAN GRANULOCYTE-COLONY-STIMULATING FACTOR (FILGRASTIM) FOLLOWING HIGH-DOSE CHEMOTHERAPY AND PERIPHERAL-BLOOD PROGENITOR-CELL RESCUE IN HIGH-GRADE NON-HODGKINS-LYMPHOMA - CLINICAL BENEFITS AT NO EXTRA COST

In order to evaluate the potential clinical and economic benefits of g ranulocyte colony-stimulating factor (G-CSF, filgrastim) following per ipheral blood progenitor cells (PBPC) rescue after high-dose chemother apy (HDCT), 23 consecutive patients aged less than 60 years with poor- prognosis, high-grade non-Hodgkin's lymphoma (NHL) were entered into a prospective randomized trial between May 1993 and September 1995. Pat ients were randomized to receive either PBPC alone (n = 12) or PBPC+G- CSF (n = II) after HDCT with busulphan and cyclophosphamide. G-CSF (30 0 mu g day(-1)) was given from day +5 until recovery of granulocyte co unt to greater than 1.0 x 10(9) l(-1) for 2 consecutive days. The mean time to achieve a granulocyte count > 0.5 x 10(9) l(-1) was significa ntly shorter in the G-CSF arm (9.7 vs 13.2 days; P<0.0001) as was the median duration of hospital stay (12 vs 15 days; P = 0.001). In additi on the recovery periods (range 9-12 vs 11-17 days to achieve a count o f 1.0 x 10(9) l(-1)) and hospital stays (range 11-14 vs 13-22 days) we re significantly less variable in patients receiving G-CSF in whom the values clustered around the median. There were no statistically signi ficant differences between the study arms in terms of days of fever, d ocumented episodes of bacteraemia, antimicrobial drug usage and platel et/red cell transfusion requirements. Taking into account the costs of total occupied-bed days, drugs, growth factor usage and haematologica l support, the mean expenditure per inpatient stay was pound 6500 (ran ge pound 5465-pound 8101) in the G-CSF group compared with pound 8316 (range pound 5953-pound 15 801) in the group not receiving G-CSF, with an observed mean saving of pound 1816 per patient (or 22% of the tota l cost) in the G-CSF group. This study suggests that after HDCT and PB PC rescue, the use of G-CSF leads to more rapid haematological recover y periods and is associated with a more predictable and shorter hospit al stay. Furthermore, and despite the additional costs for G-CSF, thes e clinical benefits are not translated into increased health care expe nditure.