Comparison of G-CSF-primed peripheral blood progenitor cells and bone marrow auto transplantation: clinical assessment and cost-effectiveness.

The introduction of hematopoietic growth factors (HGFs) offers new opportunities for autologous transplantation by facilitating and enriching collection of circulating progenitor cells from peripheral blood as a source of stem cell rescue. Substitution of peripheral blood progenitor cells (PBPC) from bone marrow in autologous transplantation for therapy in advanced cancers requires clinical and economic assessment. We carried out the first clinical and cost-effectiveness study in an experimental group of 16 patients autografted with PBPC primed by G-CSF alone and with G-CSF stimulation post-transplantation, comparing these with two other groups of 17 and 21 patients who received autologous bone marrow transplantation with and without G-CSF stimulation, respectively, post-transplantation. We confirmed the ability of primed PBPC to achieve durable engraftment in a shorter time than classical BMT (median number of days to reach 0.5 x 10(9)/l neutrophils = 10.5 versus 12 and 16, respectively) to improve overall hematological recovery (median number of days to recover a platelet count > or = 25 x 10(9)/l, independent of platelet transfusion = 14.5 vs 23 and 20) and to shorten length of hospitalization. Total costs of PBPC autografting remain lower than those of autologous BMT either with or without G-CSF, and cost-effectiveness ratios using hematological recovery end points are in favour of PBPC. Finally, PBPC is a safe and effective way of performing dose-intensification in cancer patients, although further improvements are required to optimize the procedure and so further decrease the costs.