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Prepublished online as a Blood First Edition Paper on June 21, 2002; DOI 10.1182/blood-2002-03-0984.
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Blood, 15 October 2002, Vol. 100, No. 8, pp. 2697-2702
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Comparison of T-cell-depleted and non-T-cell-depleted
unrelated donor transplantation for hematologic diseases: clinical
outcomes, quality of life, and costs
Stephanie J. Lee,
David Zahrieh,
Edwin P. Alyea,
Edie Weller,
Vincent T. Ho,
Joseph H. Antin, and
Robert J. Soiffer
From the Department of Adult Oncology and Department of
Biostatistical Science, Dana-Farber Cancer Institute, and the
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
T-cell depletion (TCD) and immunosuppressive medications (ISTs) are
2 methods used for graft-versus-host disease (GVHD) prophylaxis in
unrelated donor (URD) transplantation. However, comparisons of the
clinical outcomes including quality of life and direct medical costs
associated with each type of procedure have not been reported. We
reviewed 48 TCD and 98 IST procedures performed from 1/1/97 to 12/31/99
at the Dana-Farber Cancer Institute, Boston, MA. With a median
follow-up of 1.5 years for survivors, no differences were seen in
relapse, acute GVHD, and overall survival between TCD and IST patients.
Multivariable Cox modeling showed that age of 50 years or less
(P = .002) and low-risk disease (P = .001) predicted survival, but method of GVHD prophylaxis
(P = .6) and degree of human leukocyte antigen (HLA)
matching (P = .8) did not. A subset of patients (53%)
completed quality of life surveys prior to and at 6 and 12 months after
transplantation; participation in the quality of
life study was not associated with clinical characteristics and
outcomes. No differences were seen in quality of life scores prior to
transplantation, and changes over time were similar between groups.
Costs ($113 000 vs $155 000, P < .0001) and total
hospital days (34 vs 46, P = .0006) were significantly lower for patients undergoing TCD procedures. As prospective, randomized studies comparing methods of GVHD prophylaxis are performed, assessment of quality of life and costs should be included to fully
understand the overall impact of each intervention.
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