Ka. Schulman et al., Effect of CD34(+) cell dose on resource utilization in patients after high-dose chemotherapy with peripheral-blood stem-cell support, J CL ONCOL, 17(4), 1999, pp. 1227-1233
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.