Low cost autologous peripheral blood stem cell transplantation performed in a municipal hospital for a patient with plasma cell leukaemia

Abstract

Autologous peripheral blood stem cell transplantation (PBSCT) is a costly procedure. In India, the cost varies from US$20000 to 25000 and most patients cannot afford it. Using several cost-cutting measures, we were able to treat a patient with plasma cell leukaemia by autologous PBSCT. A 42-year-old-male presented with plasma cell leukaemia. He was treated with VAD therapy, followed by high-dose cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) for mobilization of peripheral blood stem cells. The patient was conditioned with high dose melphalan, followed by autologous PBSCT. The procedure was performed in a municipal hospital in which there was no prior experience with stem cell transplantation. Costs were reduced by: (i) using oral medication whenever possible; (ii) having a relative of the patient prepare his food under medical guidance; (iii) starting G-CSF on day 7 rather than on day 1; (iv) short-term storage of the PBSC in an ordinary refrigerator at 4 degrees C without cryopreservation; (v) infusing a large number of CD34+ cells, which shortened the time to engraftment; (vi) delegating many of the functions of a marrow transplant nurse to a resident physician. The cost of transplantation was thereby reduced to about US$ 6000, with successful engraftment by day +13. The patient remained in remission for 7 months, after which he relapsed and was treated with chemotherapy and electron beam radiation to the skin.

Clinico-Pathological Spectrum of Primary Plasma Cell Leukemia Diagnosed at a Tertiary Care Centre in South India Over 5 Year Period

“…The presence of p53 deletion, 13q deletions, karyotypic complexity, hypodiploidy and 1q gains could confer an advanced stage on PC disease progression characterized by therapy resistance and a dismal prognosis [17]. There are older sporadic reports from India of treatment of primary PCL with single agent ifosfamide [18] and more recent reports of autologous stem cell transplantation in patients with pPCL who relapsed after initial remission [19,20]. Unlike MM, survival with PCL has not improved over time.…”

Cost analysis of autologous peripheral blood stem cell transplantation for multiple myeloma

“…Contrary to this analysis, the cost related to the hematopoietic stimulating factor was excluded. In a recent study, Ghosh et al (2002) reported that the PBSC cost for a patient with plasma cell leukemia was US$20 000-25 000. The major part of the costs was related to hospitalization, growth factors, blood products, collection and cryopreservation of PBSC.…”

“…Contrary to this analysis, the cost related to the hematopoietic stimulating factor was excluded. In a recent study, Ghosh et al. (2002) reported that the PBSC cost for a patient with plasma cell leukemia was US$20 000–25 000.…”

Hematopoietic stem cells from peripheral blood the perspective of non-mobilized peripheral blood

“…In another study, Ghosh et al [40] reported a PBSCT cost for patients with plasma cell leukemia that ranged from US$ 20000 to US$ 25000. The major part of the costs related to hospitalization, growth factors, blood products, collection and cryopreservation of PBSC.…”