Effect of CD34+ Cell Dose on Resource Utilization in Patients After High-Dose Chemotherapy With Peripheral-Blood Stem-Cell Support

Abstract

PURPOSE: The mean time to neutrophil and platelet recovery for patients receiving high-dose chemotherapy (HDC) supported with peripheral-blood stem cells (PBSCs) is related to the dose of CD34+ cells infused. The effect of cell dose on resource utilization after transplantation has not been previously reported. MATERIALS AND METHODS: We assessed CD34+ cell dose and resource utilization for 1,317 patients undergoing transplantation with PBSCs from April 1991 to June 1997. PBSCs were collected after mobilization with chemotherapy and recombinant human granulocyte colony-stimulating factor (rhG-CSF). Daily measurement of the CD34+ content of the PBSC collection was performed by a central laboratory using a single CD34+ analysis technique. Resource utilization included engraftment parameters, length of stay, and transfusion requirements for 100 days posttransplantation. Analysis included descriptive statistics and multiple regression. RESULTS: Mean patient age was 47 years, and 86% of patients were female. Median cell dose was 3.6 × 106/kg and 13.2 × 106/kg for patients receiving less than 5.0 × 106 CD34+ cells/kg and 5.0 × 106 or more CD34+ cells/kg, respectively. Patients receiving less than 5.0 × 106 CD34+ cells/kg were more likely to have metastatic breast cancer or non-Hodgkin's lymphoma and required more platelet and RBC transfusions, 3.3 more hospital days, and increased antibiotic and antifungal use. In univariate analysis, the cost of care was $41,516 (±$20,876 SD) and $32,382 (±$16,353 SD) for patients with less than 5.0 × 106 CD34+ cells/kg and 5.0 × 106 or more CD34+ cells/kg, respectively. In multivariate analysis, patients with less than 5.0 × 106 CD34+ cells/kg had an increase in costs of $5,062 (± $1,262 SE). CONCLUSION: Infusion of more than 5.0 × 106 CD34+ cells/kg was associated with a reduction in resource utilization. Achieving a target of 5.0 × 106 CD34+ cells/kg should have important clinical and economic benefits for patients.