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Blood, Vol. 92 No. 8 (October 15), 1998:
pp. 2725-2729
Efficacy and Costs of Granulocyte Colony-Stimulating Factor in
Allogeneic T-Cell Depleted Bone Marrow Transplantation
Stephanie J. Lee,
Edie Weller,
Edwin P. Alyea,
Jerome Ritz, and
Robert J. Soiffer
From the Center for Hematologic Oncology, Department of Adult
Oncology and the Department of Biostatistics, Dana-Farber Cancer
Institute, and Harvard Medical School, Boston, MA.
Hematopoietic growth factors have shown clinical benefits in
patients undergoing chemotherapy and stem cell transplantation, but few
studies have been performed to assess whether the benefits are worth
the costs. We reviewed 196 patients undergoing T-cell depleted related
donor bone marrow transplantation (BMT) between 1990 and 1996 to assess
the effect of growth factor use on time to engraftment and costs of
hospitalization. Beginning in 1994, based on encouraging results in
autologous transplantation, patients (n = 81) were treated with
granulocyte colony-stimulating factor (G-CSF) starting at day +1
after marrow infusion until engraftment. Between January 1, 1990 and
January 1, 1994, patients (n = 115) did not receive growth factor.
CD6 depletion of donor marrow was the only form of prophylaxis against
graft-versus-host disease (GVHD). Despite receiving a lower stem cell
dose (P = .004), the group receiving G-CSF had a decreased
time to engraftment (20 days v 12 days, P < .0001)
and time from marrow infusion to discharge (23 days v 17 days,
P < .0001). In multivariate modeling, the use of G-CSF was
the most significant factor predicting time to engraftment and
discharge. Incidence of grades II-IV GVHD, early mortality, percentage
of patients who engrafted, and relapse rates did not differ between the
groups. Inpatient charges during the first 50 days after marrow
infusion (including readmissions) were available on 110 patients and
were converted to costs using departmental ratios of costs of charges.
Median costs were significantly lower in the group receiving G-CSF
($80,600 v $84,000, P = .0373). Thus, use of G-CSF in
this setting allows earlier hospital discharge with lower costs.
© 1998 by The American Society of Hematology.
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