A Cost-Benefit Analyses Comparing Haploidentical Transplantation with Hla Matched Sibling and Urd in Hematological Malignancies

BackgroundHaploidentical (haplo) stem cell transplantation has demonstrated intensive graft vs. leukemia effect and survival advantage in patients with advanced leukemia. However, early virus reactivation and acute GVHD may dramatically increase the cost of treatment. Here we investigate the impact of donor types on clinical outcomes and cost of treatment within 100 days of transplant.MethodsThe study cohort consists of 117 consecutive patients (28 matched siblings, 25 unrelated and 64 haplo) with 115 leukemia, 1 SAA, and 1 NHL. The median age is 20 years (3-62). Conditioning regimens: 1) Ara-C+BUCY (n = 14); 2) Ara-C+ BUFlu (n = 12). In addition, Haplo and URD received either 3) Ara-C+ BUCY +ATG (n = 54) or, 4) Ara-C+BUFlu+ATG. (n = 32) followed by unmanipulated G-CSF mobilized bone marrow and/or peripheral blood (G-BMPB or G-PB). 5 patients used other regimen. GVHD prophylaxis: CSA, MMF and short-term MTX. Multiple linear regression models were used for cost analysis. Variables considered were: transplant type (Sibling vs. URD vs. Haplo), quality of life (QOL), D/R sex match, patient age by decade, comorbidity, diagnoses, disease status pre-transplant, conditioning regimen, graft type, MNC, CD34+cells, ANC and platelet engraftment, AGVHD and death.ResultsTable 1Clinical Outcomes after transplantationSiblingURDHaploPTRM 100 day0 (0-0)%9 (2-24)%5 (1-12)%0.0634TRM 1 year12 (3-27)%15 (4-32)%14 (7-24)%0.9488Relapse 100 day11 (3-25)%4 (0-16)%3 (1-10)%0.4640Relapse 1 year23 (10-40)%19 (9-41)%9 (3-18)%0.2187DFS 100 day89 (70-96)%87 (65-96)%92 (82-97)%0.7817DFS 1 year65 (43-80)%67 (37-84)%77 (63-86)%0.4721Survival 100 day96 (77-99)%91 (69-98)%94 (84-98)%0.7430Survival 1 year84 (63-94)%78 (49-91)%83 (70-90)%0.8780 Open table in a new tab ConclusionThese data suggest that transplant type (Sibling vs. URD vs. Haplo) does not significantly effect on the clinical outcomes and 100-day cost of transplantation. Future studies with more patients and longer follow-up are warranted. BackgroundHaploidentical (haplo) stem cell transplantation has demonstrated intensive graft vs. leukemia effect and survival advantage in patients with advanced leukemia. However, early virus reactivation and acute GVHD may dramatically increase the cost of treatment. Here we investigate the impact of donor types on clinical outcomes and cost of treatment within 100 days of transplant. Haploidentical (haplo) stem cell transplantation has demonstrated intensive graft vs. leukemia effect and survival advantage in patients with advanced leukemia. However, early virus reactivation and acute GVHD may dramatically increase the cost of treatment. Here we investigate the impact of donor types on clinical outcomes and cost of treatment within 100 days of transplant. MethodsThe study cohort consists of 117 consecutive patients (28 matched siblings, 25 unrelated and 64 haplo) with 115 leukemia, 1 SAA, and 1 NHL. The median age is 20 years (3-62). Conditioning regimens: 1) Ara-C+BUCY (n = 14); 2) Ara-C+ BUFlu (n = 12). In addition, Haplo and URD received either 3) Ara-C+ BUCY +ATG (n = 54) or, 4) Ara-C+BUFlu+ATG. (n = 32) followed by unmanipulated G-CSF mobilized bone marrow and/or peripheral blood (G-BMPB or G-PB). 5 patients used other regimen. GVHD prophylaxis: CSA, MMF and short-term MTX. Multiple linear regression models were used for cost analysis. Variables considered were: transplant type (Sibling vs. URD vs. Haplo), quality of life (QOL), D/R sex match, patient age by decade, comorbidity, diagnoses, disease status pre-transplant, conditioning regimen, graft type, MNC, CD34+cells, ANC and platelet engraftment, AGVHD and death. The study cohort consists of 117 consecutive patients (28 matched siblings, 25 unrelated and 64 haplo) with 115 leukemia, 1 SAA, and 1 NHL. The median age is 20 years (3-62). Conditioning regimens: 1) Ara-C+BUCY (n = 14); 2) Ara-C+ BUFlu (n = 12). In addition, Haplo and URD received either 3) Ara-C+ BUCY +ATG (n = 54) or, 4) Ara-C+BUFlu+ATG. (n = 32) followed by unmanipulated G-CSF mobilized bone marrow and/or peripheral blood (G-BMPB or G-PB). 5 patients used other regimen. GVHD prophylaxis: CSA, MMF and short-term MTX. Multiple linear regression models were used for cost analysis. Variables considered were: transplant type (Sibling vs. URD vs. Haplo), quality of life (QOL), D/R sex match, patient age by decade, comorbidity, diagnoses, disease status pre-transplant, conditioning regimen, graft type, MNC, CD34+cells, ANC and platelet engraftment, AGVHD and death. ResultsTable 1Clinical Outcomes after transplantationSiblingURDHaploPTRM 100 day0 (0-0)%9 (2-24)%5 (1-12)%0.0634TRM 1 year12 (3-27)%15 (4-32)%14 (7-24)%0.9488Relapse 100 day11 (3-25)%4 (0-16)%3 (1-10)%0.4640Relapse 1 year23 (10-40)%19 (9-41)%9 (3-18)%0.2187DFS 100 day89 (70-96)%87 (65-96)%92 (82-97)%0.7817DFS 1 year65 (43-80)%67 (37-84)%77 (63-86)%0.4721Survival 100 day96 (77-99)%91 (69-98)%94 (84-98)%0.7430Survival 1 year84 (63-94)%78 (49-91)%83 (70-90)%0.8780 Open table in a new tab ConclusionThese data suggest that transplant type (Sibling vs. URD vs. Haplo) does not significantly effect on the clinical outcomes and 100-day cost of transplantation. Future studies with more patients and longer follow-up are warranted. These data suggest that transplant type (Sibling vs. URD vs. Haplo) does not significantly effect on the clinical outcomes and 100-day cost of transplantation. Future studies with more patients and longer follow-up are warranted.