CD34+CD33- cells influence days to engraftment and transfusion requirements in autologous blood stem-cell recipients.

Summary:Intensive high-dose chemotherapy with peripheral blood progenitor cell (PBPC) transplantation is a common strategy for aggressive non-Hodgkin's lymphomas (NHL). A retrospective cost-effectiveness analysis of CD34 ؉ cell dose was carried out. Between 1994 and 1998, 28 patients were included. Efficacy was measured by the length of aplasia. Data collection concerned the period from graft day until discharge from hospital, and the post-graft period until graft day ؉100. Patients transplanted using a cell dose greater than 5 ؋ 10 6 /kg were found to have a faster hematological recovery. Average length of post-graft hospitalization was shorter and fewer blood products were required for patients with more than 5 ؋ 10 6 /kg CD34 ؉ cells transplanted. Hospitalization was the major cost driver. A large reduction in procedure cost was obtained with a CD34 ؉ cell count higher than 5 ؋ 10 6 /kg (؊US$2740, ؊11%). This difference was directly related to hospitalization (−US$860) and platelet units transfused (؊US$1,340). A sensitivity analysis showed the robustness of results. Our findings indicated that a CD34 ؉ cell dose higher than 5 ؋ 10 6 /kg was more cost-effective than a lower dose in NHL patients. The collection of 5 ؋ 10 6 /kg CD34 ؉ cells appeared necessary to optimize the PBPC procedure. Bone Marrow Transplantation (2000) 25, 997-1002. Keywords: cost-effectiveness; peripheral blood stem cell transplantation; CD34; lymphoma; G-CSF; GM-CSF Intensive high-dose chemotherapy (HDC) with autologous progenitor cells is a common treatment strategy for relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL). 1-3 Previous results in first-line therapy are encouraging for patients with more than one adverse prognosis factor. 4,5 Over the past several years, there has been a transition from the use of autologous bone marrow (ABMT) to autologous peripheral blood progenitor cell transplantation (PBPCT). Neutrophil and platelet recovery have been improved. 6,7 This has resulted in significant cost savings. [7][8][9][10][11] The French National Health Insurance is concerned, as in many countries, by the increasing high cost of health care. 12 Therefore, resource allocation should be optimized. The graft progenitor cell content appears to be the major factor predicting granulocyte and platelet recovery. [13][14][15][16][17] Recently, two studies (not published) including solid tumors and hematological malignancies, showed that implementing optimal progenitor content would reduce resource consumption for PBPC patients. 18,19 Here, retrospective costeffectiveness analysis of CD34 + cell dose was carried out in aggressive non-Hodgkin's lymphomas, from the hospital perspective. Materials and methods PatientsConsecutive patients treated in the Besançon University Hospital hematology ward with HDC followed by PBPCT for aggressive NHL between 1994 and 1998 were included, independently of inclusion in a randomized trial. Doublegraft procedure patients were excluded. For patients with two independent transplantations during thi...

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of CD34+ dose in peripheral blood progenitor cell transplantation for non-Hodgkin’s lymphoma patients: a single centre study

Limat

Woronoff‐Lemsi

Deconinck

et al. 2000

“…In our study, days to neutrophil and platelet recovery were significantly greater (P = 0.001) in patients who received a total CD34 + blood stem cell dose of р2.5 vs Ͼ 2.5, р5 vs Ͼ5, and р10 vs Ͼ10 × 10 6 /kg (Table 1). 18 In contrast, days to neutrophil and platelet recovery were similar in patients who received a total CD34 + cell dose of 10 or Ͼ10 × 10 6 /kg. These data suggest that a minimum of 7 days to achieve a neutrophil count of 500 cells/ l and 12 days for 50 000 platelets/ l will be observed after high-dose chemotherapy regardless of the blood stem cell dose.…”

Section: Predictors Of Hematopoietic Recoverymentioning

confidence: 76%

“…A recent analysis of 375 consecutive autologous blood stem cell transplant patients revealed CD34 + stem cell dose to be a highly significant (P = 0.001) predictor of hematopoietic recovery rates. 18 However, other variables, including patient diagnosis, conditioning regimen, and peritransplant complications and medication appear to alter the effect of CD34 + stem cell dose on hematopoietic recovery. 3,4,18 Regardless, the relationship between CD34 + stem cell dose and the rate of hematopoietic recovery has been greatly clarified by recent studies.…”

Section: Predictors Of Hematopoietic Recoverymentioning

confidence: 99%

“…18 However, other variables, including patient diagnosis, conditioning regimen, and peritransplant complications and medication appear to alter the effect of CD34 + stem cell dose on hematopoietic recovery. 3,4,18 Regardless, the relationship between CD34 + stem cell dose and the rate of hematopoietic recovery has been greatly clarified by recent studies. In an analysis of 600 patients, Weaver et al observed that as the CD34 + stem cell dose was increased from 2.5 to 5 × 10 6 /kg, the median time to achieve an absolute neutrophil count of 500 cells/ l dropped significantly.…”

Section: Predictors Of Hematopoietic Recoverymentioning

confidence: 99%

See 1 more Smart Citation

Impact of stem cell dose on hematopoietic recovery in autologous blood stem cell recipients

Pecora

1999

Summary:Hematopoietic recovery rates following high-dose chemotherapy in autologous blood stem cell recipients have been shown, in part, to be dependent on the source and quantity of hematopoietic stem cells infused. Mobilized blood stem cell quantity (identified by the surface expression of the CD34 antigen) has been demonstrated in multiple studies to be the strongest predictor of days to hematopoietic recovery (ie platelets and neutrophils) in autologous blood stem cell recipients. Additionally, data from four large studies confirm that prompt and sustained hematopoietic recovery will occur in the majority of patients treated with high-dose chemotherapy if a stem cell dose у5 × 10 6 /kg is administered. However, multiple aphereses are needed in the majority of patients to achieve these optimal stem cell doses. Problems associated with multiple aphereses procedures include hypocalcemia, anemia, thrombocytopenia, infection, thrombosis, increased costs, and malignant cell contamination of the apheresis product. Recent data indicate that less differentiated (eg CD33 − ) stem and progenitor cells result in both early and sustained hematopoietic recovery in bone marrow and blood stem cell recipients. Future trials using new growth factors such as stem cell factor (which has been shown to increase CD34 + /CD33 − cell mobilization), as well as improvements in purging strategies are needed to ensure prompt, sustained, and malignant-cell-free engraftment for the majority of autologous blood stem cell recipients.

“…15,26,27 This emphasizes the practical importance of effective mobilization in breast cancer patients in order to improve the CD34 + cell yields. 5,[11][12][13][14] However, even with no or limited prior antineoplastic treatment, the number of PBPCs collected is variable among patients and 10% of them will fail to mobilize successfully.…”

Section: Discussionmentioning

confidence: 99%

Cyclophosphamide and paclitaxel as initial or salvage regimen for the mobilization of peripheral blood progenitor cells

Rey

Dansey

et al. 1999

Summary:Peripheral blood progenitor cells are now commonly used for hematologic reconstitution after myelosuppressive chemotherapy for hematologic and solid malignancies. The purpose of this study was to evaluate the activity of paclitaxel 170 mg/m 2 and cyclophosphamide 2 g/m 2 (CP) with filgrastim (human G-CSF) for mobilization of PBPCs as the first or second maneuver after failure with filgrastim alone. Sixty-four patients with stage II-IV breast cancer received (CP) followed by filgrastim (10 g/kg/day). In 35 (55%) this was the first maneuver while it was for salvage in 29 (45%) patients. The median number of aphereses was two (range, 1-7). In 83% of the patients apheresis was initiated on days 10-11 following chemotherapy. The median numbers of CD34 + cells/kg, CD34 + cells/apheresis/kg and total nucleated cells/kg collected were 8.7 × 10 6 (2.11-73.5), 3.97 × 10 6 (0.3-36.75) and 164.15 × 10 8 (9-660), respectively. All the patients yielded at least 2 × 10 6 CD34 + cells/kg. CP mobilization salvaged the 29 patients who failed mobilization with filgrastim alone. When used as first-line mobilization the yield of CD34 + cells × 10 6 /kg was higher than in the salvage group (16.93 vs 3.94, P Ͻ 0.001). Patients receiving CP as salvage reached the target of 5 × 10 6 CD34 + cells/kg in only 45% (13/29) of cases vs 94.3% as first maneuver. CP followed by filgrastim is a safe and effective regimen for the mobilization of PBPCs in patients with breast cancer and shows significant activity in patients who failed to mobilize with filgrastim, suggesting a higher mobilization potential.