Peripheral Blood Stem Cell and Bone Marrow Transplantation for Solid Tumors and Lymphomas: Hematologic Recovery and Costs: A Randomized, Controlled Trial

Hartmann, Olivier; Corroller, Anne-Gaëlle Le; Blaise, Didier; Michon, Jean; Philip, I; Norol, Françoise; Janvier, Maud; Pico, Jose Louis; Baranzelli, M. C.; Rubie, H; Coze, Carole; Pinna, Antonella; Méresse, Valérie; Benhamou, E

doi:10.7326/0003-4819-126-8-199704150-00002

Cited by 225 publications

(131 citation statements)

References 29 publications

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“…34,56,57 The target dose of infused CD34 þ cells varies from a minimum of 2.0 Â 10 6 CD34 þ cells/kg 31,58,59 to an optimal level of 5.0 Â 10 6 CD34 þ cells/kg. 24,26,55 Within this range, higher doses of infused CD34 þ cells are more beneficial for patients with MM and NHL.…”

Section: Mobilization Agent Mechanismmentioning

confidence: 99%

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Improving stem cell mobilization strategies: future directions

Bensinger

DiPersio

McCarty

2009

Bone Marrow Transplant

198

209

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Section: Mobilization Agent Mechanismmentioning

confidence: 99%

“…Cytokines approved for mobilization GM-CSF 34,56 because collection is easier, morbidity is reduced and the tempo of engraftment is quicker. 34,56,57 The target dose of infused CD34 þ cells varies from a minimum of 2.0 Â 10 6 CD34 þ cells/kg 31,58,59 to an optimal level of 5.0 Â 10 6 CD34 þ cells/kg.…”

Section: Mobilization Agent Mechanismmentioning

confidence: 99%

Improving stem cell mobilization strategies: future directions

Bensinger

DiPersio

McCarty

2009

Bone Marrow Transplant

198

209

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“…Although a reduction in aplasia duration, thanks to the generalized use of PBSC, has brought about significantly reduced length of inpatient stay, conventional hospital-based follow-up remains an important cost driver of auto-SCT. [1][2][3][4] Traditionally, patients stay in the transplant unit for a period of 3-4 weeks during which they receive HDCT and PBSC infusion with aplasia-supportive-care follow-up. Over the past decade, a number of studies have investigated the efficacy, safety and cost advantages of reduced hospitalization for auto-SCT.…”

Section: Introductionmentioning

confidence: 99%

Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs

Faucher

Corroller

Esterni

et al. 2011

Bone Marrow Transplant

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We report the first randomized study comparing early hospital discharge with standard hospital-based follow-up after high-dose chemotherapy (HDCT) and PBSCT. Patients aged 18-65 years, with an indication of PBSCT for non-leukemic malignant diseases were randomly assigned between two arms. Arm A consisted of early hospital discharge (HDCT during hospitalization, discharge at day 0, home stay with a caregiver, outpatient clinic follow-up). In arm B patients were followed up as inpatients. In total 131 patients were analyzed (66 in arm A and 65 in arm B). Patient characteristics and hematological reconstitution were comparable between the two groups. In arm A, 26 patients were actually discharged early. Patients in group A spent fewer days in hospital (11 vs 12 days, P ¼ 0.006). This strategy resulted in a 6% mean cost reduction per patient when compared with the conventional hospital-based group. The early discharge approach within the French health system, while safe and feasible, is highly dependent on social criteria (caregiver availability and home to hospital distance). It is almost always associated with conventional hospital readmission during the aplasia phase, and limits cost savings when considering the whole population of patients benefiting from HDCT in routine clinical practice.

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“…Indeed, three opportunistic infections (two pneumocistis pneumonia, one invasive lung aspergillus infection), were observed in the highest two dose levels tested (eight patients). While these opportunistic infections are frequent after allogenous bone marrow transplantation, they are infrequently encountered after autologous bone marrow transplantation for solid tumours, in particular using PBPC (Hartmann et al, 1997). High-dose alkylating agents are known to impair T-cell immunity, particularly of CD4+ cells (Mackall et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

A phase I/II study of 4 monthly courses of high-dose cyclophosphamide and thiotepa for metastatic breast cancer patients

et al. 2002

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This pilot phase I/II study intended to determine the maximum tolerated dose of cyclophosphamide and thiotepa administered on four consecutive courses with peripheral blood progenitor cell and granulocyte-colony stimulating factor support, as firstline therapy for hormone-refractory metastatic breast cancer patients. Twenty-eight patients were entered in the study. After two courses of epirubicin (120 mg m 72 ) and cyclophosphamide (2 g m 72 ) followed by granulocyte-colony stimulating factor injection and leukaphereses, patients received four cycles of cyclophosphamide and thiotepa. Each cycle was followed by peripheral blood progenitor cell and granulocyte-colony stimulating factor supports, then repeated every 28 to 35 days. Six escalating dose levels of cyclophosphamide and thiotepa were planned, beginning at cyclophosphamide 1.5 g m 72 and thiotepa 200 mg m 72 . At least three patients were enrolled for each dose level. Eighteen patients completed the study. The maximum tolerated dose was 3000 mg m 72 cyclophosphamide and 400 mg m 72 thiotepa per course. Haematological toxicity was manageable on an outpatient basis and did not increase significantly with dose escalation. Dose-limiting toxicity was chemotherapy-induced immuno-suppression, which resulted in one toxic death and two life-threatening infections. Median times to treatment failure and survival were 11 and 26 months, respectively. Three patients were alive, free of disease 30 months after completion of the study. Such therapy allows for high-dose intensity and high cumulative doses on a short period of time with manageable toxicity.

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Peripheral Blood Stem Cell and Bone Marrow Transplantation for Solid Tumors and Lymphomas: Hematologic Recovery and Costs: A Randomized, Controlled Trial

Abstract: Transplantation of PBSCs is associated with more rapid hematologic recovery than is bone marrow transplantation after high-dose chemotherapy for solid tumors or lymphomas. Furthermore, global costs are lower and cost-effectiveness ratios are better with PBSC transplantation.

Cited by 225 publications

References 29 publications

Improving stem cell mobilization strategies: future directions

Improving stem cell mobilization strategies: future directions

Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs

A phase I/II study of 4 monthly courses of high-dose cyclophosphamide and thiotepa for metastatic breast cancer patients

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