Unrelated-donor marrow transplantation is a potential option for transplant candidates lacking a compatible related donor. The T-cell Depletion Study compared the 3-year disease-free survival for patients receiving T-cell-depleted (TCD) donor marrow (n=203) vs unmanipulated donor marrow with methotrexate and cyclosporine (M/C) (n=207). Hospital costs during index admission were documented with billing data, while hospital costs during subsequent 6-month follow-up were estimated from case report forms. Patients with index admission billing were included in the analysis (TCD=119, M/C=127). Total hospital length of stay (LOS) was similar across groups, with medians 47.0 days for TCD and 52.0 days for M/C (P=0.72). Total hospital costs were comparable, $145 115 vs $141 981 (P=0.63) for TCD and M/C, respectively. However, controlling for site and patient characteristics, TCD was associated with a 12.1% reduction in LOS for the index admission (95% CI-19.4%, -4.3%). Independent of treatment, HLA matching (6/6) was associated with an 8.6% (95% CI -17.4%, +1.2%) reduction in the index admission LOS, while cost was lower by 15.8% (95% CI -26.7%, -3.3%). Treatment costs were similar for TCD and M/C study groups. Savings on reduced cost for treating acute graft-versus-host disease were likely offset by increase in serious infections in the TCD arm.
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We thank the patients who willingly entered this large clinical trial, the physicians, nurses, and other support staff who cared for them during the transplant procedure, and the clinical investigation team at each participating institution for data collection and follow-up. We also thank the National Heart, Lung, and Blood Institute (NHLBI) for support of this trial. In addition to the authors, the following transplant centers, study physicians, and experts contributed to this study: University of Minnesota (N = 103; John E Wagner, MD and Stella M Davies, MBBS, PhD), Memorial Sloan-Kettering Cancer Center (N = 70; Esperanza Papadopoulos, MD, Richard O’Reilly, MD), Medical College of Virginia (N = 53), Wake-Forest University-School of Medicine (N = 36), University of Nebraska (N = 34; Stephen Pavletic, MD, Michael Bishop, MD), University of Utah (N = 33; Finn Bo Petersen, MD), Stanford University (N = 25; Robert Negrin, MD), University of Iowa (N = 19; Robert Gingrich, MD), University of South Carolina (N = 13), Ohio State University (N = 6; Edward Copelan, MD), Duke University (N = 6; Joanne Kurtzberg, MD), University of Kentucky (N = 5; John S Thompson, MD, Gordon Phillips, MD), Medical College of Wisconsin (N = 4; James Casper, MD, Carolyn Keever-Taylor, MD, William Drobyski, MD, Neal Flomenberg, MD), Western Pennsylvania Hospital (N = 2; Richard Shattuck, MD), and University of Pittsburgh (N = 1; Albert Donnenberg, PhD), the EMMES Corporation (Donald Stablein, PhD, Adam Mendizabal, MS, Elizabeth Wagner, MPH), NHLBI (LeeAnn Jensen, PhD, Nancy Geller, PhD, Paul McCurdy, MD), MEDTAP International (Sandra Macker). This trial was supported by a contract from the National Heart, Lung and Blood Institute (N01-HB-47094 (GL, SLC and ME), N01-HB-47097 (DH, PB, JHD, and SY), N01-HB-47098 (NAK), and N01-HB-47095 (DW)).
- T-cell depletion