Autologous peripheral blood stem cell transplantation in patients with relapsed lymphoma results in accelerated haematopoietic reconstitution, improved quality of life and cost reduction compared with bone marrow transplantation: the Hovon 22 study

The present study analysed whether autologous peripheral blood stem cell tr ansplantation (PSCT) improves engraftment, quality of life and cost-effecti veness when compared with autologous bone marrow transplantation (ABMT). Re lapsing progressive lymphoma patients (n = 204; non-Hodgkin's lymphoma n = 166; Hodgkin's disease n = 38) were, after induction treatment with the DHA P-VIM (cisplatin, cytarabine, dexamethasone, etoposide, ifosfamide, methotr exate) regimen, randomly (2:1) assigned to the harvest of granulocyte-macro phage colony-stimulating factor-mobilized stem cells after the second DHAP course or autologous bone marrow cells before the second DHAP course. These stem cells were reinfused following high-dose myeloblative chemotherapy. A fter induction, 118 patients obtained a partial or complete response and we re eligible for randomization. In the PSCT arm (n = 76) significantly faste r engraftment of neutrophils [greater than or equal to 0.1 and; greater tha n or equal to 0.5 x 10(9)/l: 10.7 d (7-36, median, range), 15 (9-45) versus 13 (8-25) and 26 (14-80), P < 0.01] and thrombocytes [<greater than or equ al to> 20 x 10(9)/l: 13 d (7-51) versus 18 (11-65), P < 0.01] were observed . In addition, significantly fewer transfusions of red blood cells [6 (0-23 ) versus 8 (2-24), P < 0.01] and platelets [4 (0-60) versus 8 (2-55), P = 0 .01] were required in the PSCT arm. These findings were associated with a s ignificant reduction in the median days of intravenous antibiotics in patie nts with fever [8.5 (0-30) versus 14 (0-34), P = 0.04] and hospital stay [2 7 (8-51) versus 34 (24-78), P < 0.05]. Quality of life demonstrated a signi ficant difference in favour of the PSCT arm. Total transplantation costs we re significantly lower in the PSCT arm [$13 954 ($4913- 29 532) versus $17 668 ($10 170-44 083) P < 0.05], as a result of the reduced hospital stay an d lower antibiotic costs. In summary, these results indicate that PSCT is s uperior to ABMT with regard to engraftment, supportive care, quality of lif e and cost.