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Prepublished online as a Blood First Edition Paper on June 21, 2002; DOI 10.1182/blood-2002-03-0984.
Submitted March 29, 2002
Accepted May 21, 2002
Comparison of T-cell depleted and non-T-cell depleted unrelated donor transplantation for hematologic diseases: clinical outcome, quality of life, and costs
Stephanie J Lee*, David Zahrieh, Edwin P Alyea, Edie Weller, Vincent T Ho, Joseph H Antin, and Robert J Soiffer
Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
Department of Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA, USA
* Corresponding author; email: sjlee{at}partners.org.
T cell depletion (TCD) and immunosuppressive medications (IST) are two methods used for graft-vs.-host disease (GVHD) prophylaxis in unrelated donor transplantation. However, comparisons of the clinical outcomes including quality of life and direct medical costs associated with each type of procedure have not been reported. We reviewed 48 TCD and 98 IST procedures performed from 1/1/97 to 12/31/99 at the Dana-Farber Cancer Institute, Boston. With a median follow-up of 1.5 years for survivors, no differences were seen in relapse, acute GVHD, and overall survival between TCD and IST patients. Multivariable Cox modeling showed that age < 50 years (p=0.002) and low-risk disease (p=0.001) predicted survival, but method of GVHD prophylaxis (p=0.6) and degree of HLA-matching (p=0.8) did not. A subset of patients (53%) completed quality of life surveys prior to and at 6 and 12 months post transplant; participation in the quality of life study was not associated with clinical characteristics and outcomes. No differences were seen in quality of life scores prior to transplantation, and changes over time were similar between groups. Costs ($113,000 vs. $155,000, p<0.0001) and total hospital days (34 vs. 46, p=0.0006) were significantly lower for patients undergoing TCD procedures. As prospective, randomized studies comparing methods of GVHD prophylaxis are performed, assessment of quality of life and costs should be included to fully understand the overall impact of each intervention.
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