scholarly journals Should HLA-identical sibling bone marrow transplants for leukemia be restricted to large centers? [see comments]

Blood ◽  
1992 ◽  
Vol 79 (10) ◽  
pp. 2771-2774 ◽  
Author(s):  
MM Horowitz ◽  
D Przepiorka ◽  
RE Champlin ◽  
RP Gale ◽  
A Gratwohl ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Chronic Phase ◽  
Marrow Transplant ◽  
Myelogenous Leukemia ◽  
Bone Marrow Transplants ◽  
Relative Risks ◽  
Disease Characteristics ◽  
First Remission ◽  
Transplant Registry

Abstract There is substantial evidence that the volume of medical procedures in a hospital has an inverse relationship with mortality. We analyzed data for 1313 recipients of HLA-identical sibling bone marrow transplants for early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in first chronic phase) to determine whether transplant outcome differed in small and large centers. Transplants were performed in 86 bone marrow transplant centers active between the years 1983 and 1988, which participated in the International Bone Marrow Transplant Registry. Twenty-one (24%) centers performed five or fewer allogeneic transplants per year during the study period; five (6%) performed more than 40 per year. After adjustment for differences in patient and disease characteristics, the relative risks of treatment- related mortality (1.53, P less than .01) and treatment failure (1.38, P less than .04) were higher among patients who received transplants at centers doing five or fewer transplants per year than among those at larger centers. Among patients receiving transplants in centers performing more than five transplants a year, there was no statistically significant correlation between number of transplants and outcome.

scholarly journals Should HLA-identical sibling bone marrow transplants for leukemia be restricted to large centers? [see comments]

Blood ◽  
1992 ◽  
Vol 79 (10) ◽  
pp. 2771-2774 ◽  
Author(s):  
MM Horowitz ◽  
D Przepiorka ◽  
RE Champlin ◽  
RP Gale ◽  
A Gratwohl ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Chronic Phase ◽  
Marrow Transplant ◽  
Myelogenous Leukemia ◽  
Bone Marrow Transplants ◽  
Relative Risks ◽  
Disease Characteristics ◽  
First Remission ◽  
Transplant Registry

There is substantial evidence that the volume of medical procedures in a hospital has an inverse relationship with mortality. We analyzed data for 1313 recipients of HLA-identical sibling bone marrow transplants for early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in first chronic phase) to determine whether transplant outcome differed in small and large centers. Transplants were performed in 86 bone marrow transplant centers active between the years 1983 and 1988, which participated in the International Bone Marrow Transplant Registry. Twenty-one (24%) centers performed five or fewer allogeneic transplants per year during the study period; five (6%) performed more than 40 per year. After adjustment for differences in patient and disease characteristics, the relative risks of treatment- related mortality (1.53, P less than .01) and treatment failure (1.38, P less than .04) were higher among patients who received transplants at centers doing five or fewer transplants per year than among those at larger centers. Among patients receiving transplants in centers performing more than five transplants a year, there was no statistically significant correlation between number of transplants and outcome.

scholarly journals Choice of pretransplant treatment and timing of transplants for chronic myelogenous leukemia in chronic phase [see comments]

Blood ◽  
1993 ◽  
Vol 82 (7) ◽  
pp. 2235-2238 ◽  
Author(s):  
JM Goldman ◽  
R Szydlo ◽  
MM Horowitz ◽  
RP Gale ◽  
RC Ash ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Chronic Myelogenous Leukemia ◽  
Chronic Phase ◽  
Marrow Transplant ◽  
Myelogenous Leukemia ◽  
Bone Marrow Transplants ◽  
Free Survival ◽  
Duration Of Disease ◽  
Transplant Registry ◽  
Median Interval

Abstract We analyzed the outcome of 450 HLA-identical sibling bone marrow transplants for chronic myelogenous leukemia (CML) in chronic phase performed between 1985 and 1990 and reported to the International Bone Marrow Transplant Registry (IBMTR). All patients received either hydroxyurea (n = 292) or busulfan (n = 158) to treat their CML before transplant. The median interval between diagnosis and transplant was 10 months (range, 1 to 191). Patients treated with hydroxyurea had a higher probability (95% confidence interval) of leukemia-free survival (LFS) at 3 years than those treated with busulfan (61% [51% to 70%] v 45% [36% to 55%], P < .0003). Probability of LFS was also higher in patients transplanted within 1 year of diagnosis (61% [53 to 68%] v 47% [38% to 57%], P < .001). After adjustment for patient and transplant covariables in a multivariate analysis, prior chemotherapy and duration of disease pretransplant were independently associated with LFS. These data support the use of hydroxyurea rather than busulfan and transplant within 1 year of diagnosis for patients with CML and an HLA-identical sibling.

scholarly journals Choice of pretransplant treatment and timing of transplants for chronic myelogenous leukemia in chronic phase [see comments]

Blood ◽  
1993 ◽  
Vol 82 (7) ◽  
pp. 2235-2238 ◽  
Author(s):  
JM Goldman ◽  
R Szydlo ◽  
MM Horowitz ◽  
RP Gale ◽  
RC Ash ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Chronic Myelogenous Leukemia ◽  
Chronic Phase ◽  
Marrow Transplant ◽  
Myelogenous Leukemia ◽  
Bone Marrow Transplants ◽  
Free Survival ◽  
Duration Of Disease ◽  
Transplant Registry ◽  
Median Interval

We analyzed the outcome of 450 HLA-identical sibling bone marrow transplants for chronic myelogenous leukemia (CML) in chronic phase performed between 1985 and 1990 and reported to the International Bone Marrow Transplant Registry (IBMTR). All patients received either hydroxyurea (n = 292) or busulfan (n = 158) to treat their CML before transplant. The median interval between diagnosis and transplant was 10 months (range, 1 to 191). Patients treated with hydroxyurea had a higher probability (95% confidence interval) of leukemia-free survival (LFS) at 3 years than those treated with busulfan (61% [51% to 70%] v 45% [36% to 55%], P < .0003). Probability of LFS was also higher in patients transplanted within 1 year of diagnosis (61% [53 to 68%] v 47% [38% to 57%], P < .001). After adjustment for patient and transplant covariables in a multivariate analysis, prior chemotherapy and duration of disease pretransplant were independently associated with LFS. These data support the use of hydroxyurea rather than busulfan and transplant within 1 year of diagnosis for patients with CML and an HLA-identical sibling.

The International Bone Marrow Transplant Registry

2002 ◽  
Vol 76 (S1) ◽  
pp. 393-397 ◽  
Author(s):  
John M. Goldman ◽  
Mary M. Horowitz
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Marrow Transplant ◽  
Transplant Registry

The Costs and Cost-Effectiveness of Unrelated Donor Bone Marrow Transplantation for Chronic Phase Chronic Myelogenous Leukemia

Blood ◽  
1998 ◽  
Vol 92 (11) ◽  
pp. 4047-4052 ◽  
Author(s):  
Stephanie J. Lee ◽  
Claudio Anasetti ◽  
Karen M. Kuntz ◽  
Jonathan Patten ◽  
Joseph H. Antin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cost Effectiveness ◽  
Chronic Myelogenous Leukemia ◽  
Chronic Phase ◽  
Marrow Transplant ◽  
Quality Adjusted Life Year ◽  
Myelogenous Leukemia ◽  
Base Case ◽  
Unrelated Donor ◽  
Donor Identification

Abstract Unrelated donor transplantation prolongs survival in some patients with chronic myelogenous leukemia (CML) in chronic phase. However, there are growing concerns about the intensive resources required for this procedure given health care budget constraints. To address this issue, we conducted a study of the costs and cost-effectiveness of unrelated donor transplantation for chronic phase CML. The costs of transplantation were derived from 157 patients from the Brigham and Women’s Hospital (BWH) and the Fred Hutchinson Cancer Research Center (FHCRC). Estimates of the effectiveness of transplantation were taken from our previous work using data from the International Bone Marrow Transplant Registry and the National Marrow Donor Program. The median cost of the first 6 months of care including donor identification, marrow collection, patient hospitalization for transplantation and all outpatient medications and readmissions through 6 months postmarrow infusion was $178,500 (range, $85,000 to $462,400) and the mean was $196,200. Mean costs for patients surviving beyond 6 months posttransplant were significantly lower than for patients dying within that period ($189,700 v $211,000, respectively,P = .03). Posttransplant follow-up costs were high for months 6 to 18, then decreased. The incremental cost-effectiveness of transplantation within 1 year of diagnosis versus -interferon therapy without transplant in the base case of a 35-year-old patient was $51,800/quality-adjusted life year (QALY) gained. Sensitivity analysis showed that most ratios were between $50,000 to $100,000/QALY or within the intermediate zone of acceptable cost-effectiveness ratios.

Sign in / Sign up

Export Citation Format

Share Document