Development of a simplified single-apheresis approach for peripheral-blood progenitor-cell transplantation in previously treated patients with lymphoma.

Jones, H. M.; Jones, S A; Watts, Mike; Khwaja, Asim; Mills, W; Fielding, Adele K.; Goldstone, Anthony H.; Linch, DC

doi:10.1200/jco.1994.12.8.1693

Cited by 90 publications

(50 citation statements)

References 11 publications

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“…Because these two locations had different charges associated with stem cell preparation, all charges for leukapheresis and cryopreservation of progenitor cells were standardized assuming adequate collection in a single procedure, which has been recently demonstrated. 9,10 Thus the charges and costs reported include standardized costs for mobilization of blood progenitor cells, leukapheresis, cryopreservation and central venous catheter insertion.…”

Section: Financial Analysismentioning

confidence: 99%

Reduced charges and costs associated with outpatient autologous stem cell transplantation

Meisenberg

Ferran

Hollenbach

et al. 1998

Bone Marrow Transplant

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Summary:High-dose chemotherapy and stem cell rescue is increasingly being delivered in the outpatient setting. Such intensive outpatient management programs have reduced the total hospital length of stay without compromising clinical outcomes. However, a detailed financial analysis of outpatient programs has not been performed. These data are the results of a prospective study of 94 patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplant in one of three settings: traditional inpatient, partial outpatient, total outpatient. Patients were allowed to choose their own treatment setting based upon the availability of a caregiver and personal preference. Total hospital length of stay and the actual cost and charges for each patient were monitored prospectively. The patients in the three groups were well balanced with regard to age and functional status prior to high-dose chemotherapy. The average length of stay was reduced from 17.3 to 8.2 to 2.7 days in the three different treatment settings (P Ͻ 0.01). Mean procedure costs were reduced from $39.7 thousand (US dollars) to $36.2 thousand to $29.4 thousand in the three treatment settings (P Ͻ 0.029). No differences in toxicity or overall response to therapy was noted. High-dose chemotherapy and stem cell rescue can be safely administered in the outpatient setting and results in significant cost savings. Keywords: bone marrow transplantation; costs; outpatient transplantation; charges High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has become an increasingly utilized therapy for a wide variety of malignant diseases. HDC/ASCR has attracted a high level of scrutiny due to the high charges and costs associated with the procedure. Indeed, in the United States it is common for this procedure to require third-party and even fourth-party review before being approved by insurers. 1 Among the reasons for the high costs of HDC/ASCR is the prolonged hospitalization traditionally required for this treatment. Even with the use of hematopoietic growth factors and mobilized blood progenitor cells, which have shortened neutropenia and allowed earlier hospital discharge, hospital stays of 16 to more than 30 days are typical. 2,3,4 Peters and colleagues, 5 at Duke University Medical Center, pioneered a structured outpatient bone marrow transplant program wherein patients received all their highdose chemotherapy as inpatients and then were discharged to a 7-day-a-week outpatient clinic located a short distance from the main hospital. These patients had stage 2-4 breast cancer and received a high-dose chemotherapy regimen which did not induce a significant rate of mucositis, esophagitis or enteritis. In that program, all outpatients were housed in a local hotel adjacent to the outpatient clinic. In 1993, the Scripps Clinic stem cell transplant program advanced this model to include patients with diseases other than breast cancer receiving other chemotherapy regimens with a higher incidence of mucositis. 6 Subsequently we developed a...

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Section: Financial Analysismentioning

confidence: 99%

Reduced charges and costs associated with outpatient autologous stem cell transplantation

Meisenberg

Ferran

Hollenbach

et al. 1998

Bone Marrow Transplant

View full text Add to dashboard Cite

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“…Fifty patients underwent mobilization with cyclophosphamide and G-CSF, as previously described. 15 Low-dose cyclophosphamide (1.5 g/m 2 ) was given intravenously on day 1, followed by G-CSF given subcutaneously at 10 g/kg (filgrastim) or a single vial of lenograstim (263 g) 24 h afterwards, and daily thereafter until mobilization was complete. Seven patients underwent an alternative mobilization regimen with ESHAP 16 (etoposide 40 mg/m 2 i.v.…”

Section: Stem Cell Mobilization and Collectionmentioning

confidence: 99%

Progenitor cell yields are frequently poor in patients with histologically indolent lymphomas especially when mobilized within 6 months of previous chemotherapy

et al. 1998

Bone Marrow Transplant

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Summary:High-dose therapy with peripheral blood stem cell (PBSC) support is a frequently used treatment option in younger patients with poor prognosis histologically indolent (low-grade) non-Hodgkin's lymphoma (NHL), usually at the time of second or subsequent response to conventional-dose therapy. We have undertaken PBSC collection in 57 patients with histologically indolent NHL mobilized with either cyclophosphamide 1.5 g/m 2 or the ESHAP regimen, followed by daily G-CSF. Progenitor cell yields were determined by quantification of CD34 + cells and GM-CFC. Twelve patients (21%) failed to achieve the minimum progenitor cell requirements of 1 × 10 6 /kg CD34 + cells or 1 × 10 5 /kg GM-CFC in their pooled harvests and 40 patients (70%) failed to achieve the optimal harvest thresholds of 3.5 × 10 6 /kg CD34 + cells or 3.5 × 10 5 /kg GM-CFC. This high failure rate is significantly higher than that in patients with histologically aggressive NHL or Hodgkin's disease. A multivariate analysis was performed to identify factors contributing to the low stem cell yields in this group. This identified the time interval from the last chemotherapy to the priming chemotherapy as the most important predictive factor. With respect to CD34 and GM-CFC numbers, on the single harvest on the day the white cell count first exceeded 5 × 10 9 /l the P values were 0.0078 and 0.0065, respectively, and for the progenitor cell values on the pooled harvests the P values were 0.004 for CD34 + cells and 0.015 for GM-CFC. Progenitor cell yields may therefore be improved in patients with low grade lymphoma by harvesting at diagnosis if no marrow disease is present, or by delaying mobilization for 6 months post-chemotherapy in patients in first or subsequent remission.

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“…22,23 Briefly, patients received chemotherapy with either cyclophosphamide 1.5 g/m 2 (patients 1 and 2) or the ESHAP regimen (etoposide 40 mg/m 2 for 4 days, methylprednisolone 500 mg daily, cytarabine 2 g/m 2 and cisplatin 25 mg/m 2 daily for 4 days) 24 followed by a single daily vial of G-CSF (lenograstim, 263 g/vial) commencing 24 h after the chemotherapy. Peripheral blood stem cells were harvested using a continuous flow cell separator when the recovery white cell count first exceeded 3 × 10 9 /l, usually days 8 and 15, respectively.…”

Section: Mobilisation and Cd34 Selectionmentioning

confidence: 99%

Feasibility of multidrug resistance (MDR-1) gene transfer in patients undergoing high-dose therapy and peripheral blood stem cell transplantation for lymphoma

et al. 1998

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We have performed a pilot study of MDR-1 gene transfer chain reaction (PCR) for vector-derived MDR-1 cDNA in patients receiving CD34-selected peripheral blood stem sequence in all cases. Analysis of peripheral blood and cell (PBSC) transplant for lymphoma. To ensure minimum bone marrow cells after transplant has, however, shown engraftment thresholds and facilitate CD34 purification, no evidence of in vivo gene transfer with a follow-up of 12, mobilisation of Ͼ2 × 10 6 CD34 cells/kg was a condition for 15 and 18 months. The effect of MDR-1 substrate drugs recruitment. Of 11 patients counselled for study entry, onlyhas not yet been tested as all patients remain in clinical five achieved this target in a single apheresis. In three conand radiological remission of their lymphoma. These senting patients, purified CD34 cells were exposed to results confirm the difficulty of achieving in vivo gene trans-A12M1 MDR-1 retroviral supernatant for 6 h, cryoprefer in human haemopoietic cells and indicate major logisserved then thawed and readministered following ablative tical constraints in PBSC mobilisation in patients with chemotherapy. No delay in engraftment was observed, relapsed and resistant disease in whom initial studies are although one patient received additional back-up cells.appropriate. Gene transfer was demonstrated by polymerase

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Development of a simplified single-apheresis approach for peripheral-blood progenitor-cell transplantation in previously treated patients with lymphoma.

Abstract: A simplified mobilization protocol is described that requires only one apheresis to achieve rapid hematologic engraftment.

Cited by 90 publications

References 11 publications

Reduced charges and costs associated with outpatient autologous stem cell transplantation

Reduced charges and costs associated with outpatient autologous stem cell transplantation

Progenitor cell yields are frequently poor in patients with histologically indolent lymphomas especially when mobilized within 6 months of previous chemotherapy

Feasibility of multidrug resistance (MDR-1) gene transfer in patients undergoing high-dose therapy and peripheral blood stem cell transplantation for lymphoma

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