VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

trary, in case of adequate collection of PBSC after the first phase, the patients
were transplanted within the 4 following months after a conditioning regimen
combining total body irradiation (TBI) and high-dose melphalan (HDM) (Group
2).
Evaluation of the cost of therapy
All expenses related to the first therapeutic phase, to the second therapeutic
phase (either conventional chemotherapy or ABSCT) and to the post-transplant
survey were wholly taken into account for estimation of the cost. Three methods
of calculation have been used: a) Calculation of the Cost Price, adding up all effective
expenses: daily hostelry package, drugs, transfusions, single usage material,
laboratory tests, X-Ray examinations, kits for PBSC collection, TBI, medical
and non-medical staff time, b) Calculation of the Global Cost Price, adding provisions
for material depreciation to the former c) Cox Model, taking in account
five pre-definite parameters (table 1) ( 5
).
Appreciation of the quality of life from therapeutic Phase 1
A staging scale starting from score 1 (normal quality of life) down to score
0.025 (bedridden patients) as proposed by Bulpitt et al ( 6
), was related to the
number of weeks that each patient spent in different scored stages since therapeutic
Phase 1. It allowed to determine a coefficient of quality of life.
Appreciation of the potential professional or housekeeping productivity
This appreciation was done for each patient according to the scale related to
age established by Dolan et al ( 7
)
Statistical analysis
The correlative parametric test was used for determination of positive or
negative correlations between cost calculation methods. The significance of difference
in overall survival and quality of life coefficient was assessed by Mann-
Whitney analysis.
RESULTS
1) Therapeutic results
Three patients died during Phase 1, one by aplasia-related sepsis, two by
uncontrolled progressive disease. The rebound phase following the chemotherapy-induced
aplasia was unsufficient to allow adequate PBSC mobilization
and collection in 7 patients, who consequently were not transplanted (Group 1).
Two of these achieved a complete remission (CR) after HDM, for 2 and 3 years
respectively, receiving only an oral maintenance chemotherapy during this period.
Nevertheless, both have relapsed, and are now difficultly controlled with
conventional chemotherapy. Five other patients remained evolutive after HDM,
of whom 3 died within 6 months; the remaining two are still alive, although almost
bedridden and uncontrolled despite conventional chemotherapy.
Ten patients were transplanted with PBSC (Group 2). All achieved CR, except
one who only partially responded; he relapsed and died 18 and 28 months
from diagnosis respectively. Four other patients died within months or years
following ABSCT: one of procedure-related complications 45 days post-trans-
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SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOCOUS BONE MARROW TRANSPLANTATION