This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schulman, K. A. Articles by Weaver, C. H. Search for Related Content PubMed PubMed Citation Articles by Schulman, K. A. Articles by Weaver, C. H. Social Bookmarking                            What's this?

Effect of CD34⁺ Cell Dose on Resource Utilization in Patients After High-Dose Chemotherapy With Peripheral-Blood Stem-Cell Support

From the Clinical Economics Research Unit, Department of Medicine, Georgetown University Medical Center, Washington, DC; and Clinical Research Division, Response Oncology, Inc, Memphis, TN.

Address reprint requests to Kevin A. Schulman, MD, Clinical Economics Research Unit, 2233 Wisconsin Ave NW, Suite 440, Washington, DC 20007; email schulmak{at}gunet.georgetown.edu

PURPOSE: The mean time to neutrophil and platelet recovery for patients receiving high-dose chemotherapy (HDC) supported with peripheral-blood stem cells (PBSCs) is related to the dose of CD34⁺ cells infused. The effect of cell dose on resource utilization after transplantation has not been previously reported.

MATERIALS AND METHODS: We assessed CD34⁺ cell dose and resource utilization for 1,317 patients undergoing transplantation with PBSCs from April 1991 to June 1997. PBSCs were collected after mobilization with chemotherapy and 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 utilization included engraftment parameters, length of stay, and transfusion requirements for 100 days posttransplantation. Analysis included descriptive statistics and multiple regression.

RESULTS: Mean patient age was 47 years, and 86% of patients were female. Median cell dose was 3.6 x 10⁶/kg and 13.2 x 10⁶/kg for patients receiving less than 5.0 x 10⁶ CD34⁺ cells/kg and 5.0 x 10⁶ or more CD34⁺ cells/kg, respectively. Patients receiving less than 5.0 x 10⁶ CD34⁺ cells/kg were more likely to have metastatic breast cancer or non-Hodgkin's lymphoma and required more platelet and RBC transfusions, 3.3 more hospital days, and increased antibiotic and antifungal use. In univariate analysis, the cost of care was $41,516 (±$20,876 SD) and $32,382 (±$16,353 SD) for patients with less than 5.0 x 10⁶ CD34⁺ cells/kg and 5.0 x 10⁶ or more CD34⁺ cells/kg, respectively. In multivariate analysis, patients with less than 5.0 x 10⁶ CD34⁺ cells/kg had an increase in costs of $5,062 (± $1,262 SE).

CONCLUSION: Infusion of more than 5.0 x 10⁶ CD34⁺ cells/kg was associated with a reduction in resource utilization. Achieving a target of 5.0 x 10⁶ CD34⁺ cells/kg should have important clinical and economic benefits for patients.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				N. Flomenberg, S. M. Devine, J. F. DiPersio, J. L. Liesveld, J. M. McCarty, S. D. Rowley, D. H. Vesole, K. Badel, and G. Calandra The use of AMD3100 plus G-CSF for autologous hematopoietic progenitor cell mobilization is superior to G-CSF alone Blood, September 1, 2005; 106(5): 1867 - 1874. [Abstract] [Full Text] [PDF]

				K. Takeyama, M. Ogura, Y. Morishima, M. Kasai, Y. Kiyama, K. Ohnishi, H. Mitsuya, F. Kawano, Y. Masaki, T. Sasaki, et al. A Dose-finding Study of Glycosylated G-CSF (Lenograstim) Combined with CHOP Therapy for Stem Cell Mobilization in Patients with Non-Hodgkin's Lymphoma Jpn. J. Clin. Oncol., February 1, 2003; 33(2): 78 - 85. [Abstract] [Full Text] [PDF]

				H. Bittencourt, V. Rocha, S. Chevret, G. Socie, H. Esperou, A. Devergie, L. Dal Cortivo, J.-P. Marolleau, F. Garnier, P. Ribaud, et al. Association of CD34 cell dose with hematopoietic recovery, infections, and other outcomes after HLA-identical sibling bone marrow transplantation Blood, April 15, 2002; 99(8): 2726 - 2733. [Abstract] [Full Text] [PDF]

				E. Ashihara, C. Shimazaki, A. Okano, M. Hatsuse, A. Okamoto, K. Shimura, R. Takahashi, T. Sumikuma, T. Inaba, N. Fujita, et al. Infusion of a High Number of CD34+ Cells Provides a Rapid Hematopoietic Recovery and Cost Savings in Autologous Peripheral Blood Stem Cell Transplantation Jpn. J. Clin. Oncol., April 1, 2002; 32(4): 135 - 139. [Abstract] [Full Text] [PDF]

				O. N. Koc, S. L. Gerson, B. W. Cooper, M. Laughlin, H. Meyerson, L. Kutteh, R. M. Fox, E. M. Szekely, N. Tainer, and H. M. Lazarus Randomized Cross-Over Trial of Progenitor-Cell Mobilization: High-Dose Cyclophosphamide Plus Granulocyte Colony-Stimulating Factor (G-CSF) Versus Granulocyte-Macrophage Colony-Stimulating Factor Plus G-CSF J. Clin. Oncol., May 9, 2000; 18(9): 1824 - 1830. [Abstract] [Full Text] [PDF]

				S. J. Lee, N. Klar, J. C. Weeks, and J. H. Antin Predicting Costs of Stem-Cell Transplantation J. Clin. Oncol., January 5, 2000; 18(1): 64 - 64. [Abstract] [Full Text] [PDF]

				C. H. Weaver, K. A. Schulman, B. Wilson-Relyea, R. Birch, W. West, and C. D. Buckner Randomized Trial of Filgrastim, Sargramostim, or Sequential Sargramostim and Filgrastim After Myelosuppressive Chemotherapy for the Harvesting of Peripheral-Blood Stem Cells J. Clin. Oncol., January 1, 2000; 18(1): 43 - 43. [Abstract] [Full Text] [PDF]