Peripheral blood stem cell and bone marrow transplantation for solid tumors and lymphomas: hematologic recovery and costs. A randomized, controlled trial

Ann Intern Med. 1997 Apr 15;126(8):600-7. doi: 10.7326/0003-4819-126-8-199704150-00002.


Background: Previous studies have suggested that peripheral blood stem cell (PBSC) transplantation has an advantage over autologous bone marrow transplantation.

Objective: To compare the hematologic recovery and costs associated with PBSC transplantation with those associated with autologous bone marrow transplantation in patients receiving high-dose chemotherapy for solid tumors or lymphomas.

Design: Multicenter, randomized, controlled clinical trial.

Setting: French Federation of Cancer Centers, located in cancer facilities or public hospitals with transplantation units.

Patients: Children and adults with solid tumors or lymphomas who were candidates for high-dose chemotherapy.

Interventions: Bone marrow or filgrastim-mobilized PBSCs.

Measurement: The major and point was the duration of thrombocytopenia (platelet count < 50 x 10(9)/L). An economic evaluation of both types of transplantation was done prospectively to measure costs and cost-effectiveness.

Results: 129 patients entered the trial; 64 had PBSC transplantation, and 65 had bone marrow transplantation. The median duration of thrombocytopenia was 16 days in the PBSC group and 35 days in the bone marrow group (P < 0.001). All of the other clinical end points studied (time to last platelet transfusion, duration of granulocytopenia, number of transfusion episodes, and duration of hospitalization) favored PBSC transplantation. A cost analysis showed that total cost was decreased by 17% in adults and 29% in children with PBSC transplantation; thus, PBSC transplantation was clearly more cost-effective than bone marrow transplantation for both platelet and granulocyte recovery.

Conclusion: Transplantation of PBSCs is associated with more rapid hematologic recovery than is bone marrow transplantation after high-dose chemotherapy for solid tumors or lymphomas. Furthermore, global costs are lower and cost-effectiveness ratios are better with PBSC transplantation.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Bone Marrow Transplantation / economics*
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Disease-Free Survival
  • Female
  • Hematopoietic Stem Cell Transplantation / economics*
  • Humans
  • Lymphoma / therapy*
  • Male
  • Middle Aged
  • Neoplasms / therapy*
  • Prospective Studies
  • Thrombocytopenia / therapy
  • Time Factors
  • Transplantation Conditioning
  • Transplantation, Autologous