Recombinant human granulocyte colony-stimulating factor (filgrastim) following high-dose chemotherapy and peripheral blood progenitor cell rescue in high-grade non-Hodgkin's lymphoma: clinical benefits at no extra cost.
AuthorsLee, Siow Ming
Radford, John A
Ryder, W David J
Morgenstern, Godfrey R
Scarffe, J Howard
AffiliationCRC Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, UK.
MetadataShow full item record
AbstractIn order to evaluate the potential clinical and economic benefits of granulocyte colony-stimulating factor (G-CSF, filgrastim) following peripheral blood progenitor cells (PBPC) rescue after high-dose chemotherapy (HDCT), 23 consecutive patients aged less than 60 years with poor-prognosis, high-grade non-Hodgkin's lymphoma (NHL) were entered into a prospective randomized trial between May 1993 and September 1995. Patients were randomized to receive either PBPC alone (n = 12) or PBPC+G-CSF (n = 11) after HDCT with busulphan and cyclophosphamide. G-CSF (300 microg day[-1]) was given from day +5 until recovery of granulocyte count to greater than 1.0 x 10(9) l(-1) for 2 consecutive days. The mean time to achieve a granulocyte count > 0.5 x 10(9) l(-1) was significantly shorter in the G-CSF arm (9.7 vs 13.2 days; P<0.0001) as was the median duration of hospital stay (12 vs 15 days; P = 0.001). In addition the recovery periods (range 9-12 vs 11-17 days to achieve a count of 1.0 x 10(9) l[-1]) and hospital stays (range 11-14 vs 13-22 days) were significantly less variable in patients receiving G-CSF in whom the values clustered around the median. There were no statistically significant differences between the study arms in terms of days of fever, documented episodes of bacteraemia, antimicrobial drug usage and platelet/red cell transfusion requirements. Taking into account the costs of total occupied-bed days, drugs, growth factor usage and haematological support, the mean expenditure per inpatient stay was pound sterling 6500 (range pound sterling 5465-pound sterling 8101) in the G-CSF group compared with pound sterling 8316 (range pound sterling 5953-pound sterling 15,801) in the group not receiving G-CSF, with an observed mean saving of 1816 per patient (or 22% of the total cost) in the G-CSF group. This study suggests that after HDCT and PBPC rescue, the use of G-CSF leads to more rapid haematological recovery periods and is associated with a more predictable and shorter hospital stay. Furthermore, and despite the additional costs for G-CSF, these clinical benefits are not translated into increased health care expenditure.
CitationRecombinant human granulocyte colony-stimulating factor (filgrastim) following high-dose chemotherapy and peripheral blood progenitor cell rescue in high-grade non-Hodgkin's lymphoma: clinical benefits at no extra cost. 1998, 77 (8):1294-9 Br. J. Cancer
JournalBritish Journal of Cancer
- Economic analysis of a randomized clinical trial to compare filgrastim-mobilized peripheral-blood progenitor-cell transplantation and autologous bone marrow transplantation in patients with Hodgkin's and non-Hodgkin's lymphoma.
- Authors: Smith TJ, Hillner BE, Schmitz N, Linch DC, Dreger P, Goldstone AH, Boogaerts MA, Ferrant A, Link H, Zander A, Yanovich S, Kitchin R, Erder MH
- Issue date: 1997 Jan
- Cost-benefit of granulocyte colony-stimulating factor administration in older patients with non-Hodgkin's lymphoma treated with combination chemotherapy.
- Authors: Zagonel V, Babare R, Merola MC, Talamini R, Lazzarini R, Tirelli U, Carbone A, Monfardini S
- Issue date: 1994
- Granulocyte colony-stimulating factor following peripheral-blood progenitor-cell transplant in non-Hodgkin's lymphoma.
- Authors: Cortelazzo S, Viero P, Bellavita P, Rossi A, Buelli M, Borleri GM, Marziali S, Bassan R, Comotti B, Rambaldi A
- Issue date: 1995 Apr
- Peripheral blood progenitor cell transplantation in lymphoma and leukemia using a single apheresis.
- Authors: Pettengell R, Morgenstern GR, Woll PJ, Chang J, Rowlands M, Young R, Radford JA, Scarffe JH, Testa NG, Crowther D
- Issue date: 1993 Dec 15
- Randomised trial of filgrastim-mobilised peripheral blood progenitor cell transplantation versus autologous bone-marrow transplantation in lymphoma patients.
- Authors: Schmitz N, Linch DC, Dreger P, Goldstone AH, Boogaerts MA, Ferrant A, Demuynck HM, Link H, Zander A, Barge A
- Issue date: 1996 Feb 10