Effect of CD34(+) cell dose on resource utilization in patients after high-dose chemotherapy with peripheral-blood stem-cell support

Purpose: The mean time to neutrophil and platelet recovery for patients rec eiving high-dose chemotherapy (HDC) supported with peripheral-blood stem ce lls (PBSCs) is related to the dose of CD34(+) cells infused. The effect of cell dose on resource utilization after transplantation has not been previo usly reported. Materials and Methods: We assessed CD34(+) cell dose and resource utilizati on for 1,317 patients undergoing transplantation with PBSCs from April 1991 to June 1997. PBSCs were collected after mobilization with chemotherapy an d recombinant human granulocyte colony-stimulating factor (rhG-CSF), Daily measurement of the CD34(+) content of the PBSC collection was performed by a central laboratory using a single CD34(+) analysis technique. Resource ut ilization included engraftment parameters, length of stay, and transfusion requirements for 100 days posttransplantation. Analysis included descriptiv e statistics and multiple regression. Results: Mean patient age was 47 years, and 86% of patients were female. Me dian cell dose was 3.6 x 10(6)/kg and 13.2 x 10(6)/kg for patients receivin g less than 5.0 x 10(6) CD34(+) cells/kg and 5.0 x 10(6) Or more CD34(+) ce lls/kg, respectively. Patients receiving less than 5.0 x 10(6) CD34(+) cell s/kg were more likely to have metastatic breast cancer or non-Hodgkin's lym phoma and required more platelet and RBC transfusions, 3.3 more hospital da ys, and increased antibiotic and antifungal use. In univariate analysis, th e cost of care was $41,516 (+/-$20,876 SD) and $32,382 (+/-$16,353 SD) for patients with less than 5.0 x 10(6) CD34(+) cells/kg and 5.0 x 10(6) or mor e CD34(+) cells/kg, respectively. In multivariate analysis, patients with l ess than 5.0 x 10(6) CD34(+) cells/kg had an increase in costs of $5,062 (/- $1,262 SE). Conclusion: Infusion of more than 5.0 x 10(6) CD34(+) cells/kg was associat ed with a reduction in resource utilization. Achieving a target of 5.0 x 10 (6) CD34(+) cells/kg should have important clinical and economic benefits f or patients. (C) 1999 by American Society of Clinical Oncology.