Clinical and economic analysis of allogeneic peripheral blood progenitor cell transplants: a Canadian perspective

Couban, Stephen; Dranitsaris, George; Andreou, Pantelis; Price, Sandra; Tinker, Lisa; Foley, Ronan; Walker, IR; Jamal, Sara; Jamal, N; Spaner, David; Lipton, Jeff H.; Meharchand, J.; Messner, HA

doi:10.1038/sj.bmt.1701504

Cited by 21 publications

(27 citation statements)

References 8 publications

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“…Similar results were reported by Bennett et al, 17 although there are reports with a different conclusion. 29 Analysis of different resource areas showed differences between the two technologies. Mobilization and apheresis costs were significantly more expensive than was the marrow harvest.…”

Section: Discussionmentioning

confidence: 99%

Clinical and economic comparison of allogeneic peripheral blood progenitor cell and bone marrow transplantation for acute lymphoblastic leukemia in children

Madero

Vicent

Ramírez

et al. 2000

Bone Marrow Transplant

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Summary:There is limited experience in the use of peripheral blood progenitor cells (PBPC) for allogeneic transplantation in children. In the present study we compared engraftment kinetics, incidence of acute and chronic graft-versus-host disease (GVHD) and the outcome and economic costs of allogeneic PBPCT vs BMT in children with ALL in a single institution. All children were transplanted in complete remission (CR) with a similar conditioning regimen and the same GVHD prophylaxis. Patients undergoing PBPCT achieved myeloid and platelet engraftment before patients undergoing BMT (P Ͻ 0.001). Platelet recovery was faster for the PBPCT group (P Ͻ 0.014 for 50 × 10 9 /l and P Ͻ 0.039 for 100 × 10 9 /l). Incidence and severity of acute and chronic GVHD were similar in both groups (acute grade 1-2: 9/13 for PBPCT vs 9/11 for BMT; chronic GVHD: 5/12 for PBPCT vs 3/8 for BMT). Hospital stay was shorter for the PBPCT than for the BMT group (28.8 days vs 42.9 days, respectively) and the PBPCT group used less clinical resources, resulting in overall lower cost for PBPCT (US $14 046) compared to BMT (US $19840). There was no statistically significant difference in DFS between PBPCT and BMT (68.4% vs 50%, respectively). Bone Marrow Transplantation (2000) 26, 269-273.

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Section: Discussionmentioning

confidence: 99%

Clinical and economic comparison of allogeneic peripheral blood progenitor cell and bone marrow transplantation for acute lymphoblastic leukemia in children

Madero

Vicent

Ramírez

et al. 2000

Bone Marrow Transplant

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“…Median follow-up for PBSC recipients was 12 months (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] and for marrow recipients it was 30 months (range, 12-62). The probability of relapse 12 months after PBSCT and BMT was similar (Figure 4), being estimated at 41% (95% CI: 17-65%) and 32% (95% CI: 6-58%), respectively (P = 0.47).…”

Section: Relapse and Survivalmentioning

confidence: 99%

mentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14] In all of these reports, growth factor mobilization was well tolerated by donors and PBSC engrafted rapidly. Neutrophil recovery was faster after PBSCT than BMT in some, 6,9,11,12,14 but not all 5,7,10,13 studies, whereas platelet recovery was uniformly more rapid in PBSC recipients. [5][6][7][9][10][11][12][13][14] The observation that mobilized peripheral blood grafts contain approximately 10-fold more T cells than marrow suggested a potential for increased graft-versus-host disease (GVHD).…”

mentioning

confidence: 99%

“…Neutrophil recovery was faster after PBSCT than BMT in some, 6,9,11,12,14 but not all 5,7,10,13 studies, whereas platelet recovery was uniformly more rapid in PBSC recipients. [5][6][7][9][10][11][12][13][14] The observation that mobilized peripheral blood grafts contain approximately 10-fold more T cells than marrow suggested a potential for increased graft-versus-host disease (GVHD). 15,16 Although no study reported to date has identified a higher incidence or severity of acute GVHD after PBSCT, four studies observed an increased probability of chronic GVHD.…”

mentioning

confidence: 99%

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Matched-pair analysis of peripheral blood stem cells compared to marrow for allogeneic transplantation

Lickliter

McGlave

DeFor

et al. 2000

Bone Marrow Transplant

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Summary:We performed a case-control analysis of 42 patients with advanced leukemia or MDS comparing peripheral blood stem cell (PBSC) with marrow grafts (BMT) from HLA-matched sibling donors. PBSC were mobilized with G-CSF (7.5 g/kg/day) and yielded a median of 6.7 ؋ 10 6 CD34 ؉ cells/kg (range, 1.6-15.0) and 2.7 ؋ 10 8 CD3 ؉ cells/kg (range, 1.1-7.1) vs marrow grafts with a median of 2.0 ؋ 10 8 nucleated cells/kg (range, 1.8-2.2). Recovery was significantly faster after PBSCT compared to BMT, with a median of 17 (range, 12-26) vs 26 (range, 16-36) days, respectively, to neutrophils Ͼ0.5 ؋ 10 9 /l (P Ͻ 0.01), and 22 (range, 12-Ͼ60) vs 42 (range, 18-Ͼ60) days, for platelet recovery (P Ͻ 0.01). Transplantation of у7 ؋ 10 6 CD34 ؉ cells/kg accelerated recovery to Ͼ20 ؋ 10 9 l platelets; median 17 days (range, 12-19) vs 23 days (range, 17-36) for those receiving Ͻ7 ؋ 10 6 /kg (P = 0.01). PBSC and marrow recipients had similar risks of grades II-IV or III-IV acute GVHD or extensive chronic GVHD (all P Ͼ 0.3). At 1 year after PBSCT and BMT, the risk of relapse was 41% and 32%, respectively (P = 0.47), and the probability of survival was 46% and 48%, respectively (P = 0.70). HLA-matched sibling PBSCT resulted in faster neutrophil and platelet engraftment compared to BMT, with no subsequent differences in acute or chronic GVHD, relapse or survival. A minimum of 7 ؋ 10 6 CD34 ؉ cells/kg in PBSC grafts may be required for very rapid platelet engraftment. Bone Marrow Transplantation (2000) 26, 723-728.

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Economic evaluation of arsenic trioxide for treatment of newly diagnosed acute promyelocytic leukaemia in Canada

Lachaine

Mathurin

Barakat³

et al. 2014

Hematological Oncology

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To assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) + all-trans retinoic acid (ATRA) for treating newly diagnosed acute promyelocytic leukaemia (APL), the cost-effectiveness of ATO + ATRA compared to ATRA + idarubicin (IDA) was assessed over a lifetime horizon using a time-dependent Markov model. The model considers four health states: complete remission, treatment failure or relapse, post-failure, and death. Markov cycle length was 1 month for the first 48 months and 1 year thereafter. Efficacy outcomes in terms of event-free survival and overall survival were taken from a head-to-head clinical trial. Costs were associated with drug and administration, adverse events (AEs), treatment of relapses, follow-up visits, and productivity losses. Utilities and disutilities associated with health states and AEs were derived from the literature. Compared to ATRA + IDA, ATRA + ATO is associated with incremental cost-effectiveness ratios (ICERs) of $CAD50,193/quality-adjusted life years (QALY) and $CAD50,338/QALY from a Canadian Ministry of Health (MoH) and societal perspectives, respectively. Results of the one-way sensitivity analysis show that ICER varied from $CAD23,045 to $CAD60,759/QALY (MoH perspective) and from $CAD23,120 to $CAD60,905/QALY (societal perspective). ATO in the first-line therapy for patients with APL can be considered a more cost-effective strategy than standard treatment from a Canadian perspective.

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Clinical and economic analysis of allogeneic peripheral blood progenitor cell transplants: a Canadian perspective

Cited by 21 publications

References 8 publications

Clinical and economic comparison of allogeneic peripheral blood progenitor cell and bone marrow transplantation for acute lymphoblastic leukemia in children

Clinical and economic comparison of allogeneic peripheral blood progenitor cell and bone marrow transplantation for acute lymphoblastic leukemia in children

Matched-pair analysis of peripheral blood stem cells compared to marrow for allogeneic transplantation

Economic evaluation of arsenic trioxide for treatment of newly diagnosed acute promyelocytic leukaemia in Canada

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