Harvesting for “A Rainy Day”: A Retrospective Analysis of Its Cost-Effectivenes and Ethical Implications.

Background: Peripheral blood stem cell (PBSC) harvesting from patients with haematological malignancies in complete remission is a frequently undertaken cautionary measure. Its aim is to provide a back-up of stem cells should the patient require high dose therapy at a later date, when harvesting may prove to be more difficult. This approach has economic and ethical implications if such harvests are not regularly used. We present a retrospective study on the use of these collections in patients with haematological malignancies.

Method: We retrospectively analysed our Stem Cell Laboratory database. All collections performed between January 1980 and December 2003 were reviewed. Endpoints included number of collections per condition group and number of collections used in each group.

Results: Over 13 years there were 1665 autologous collections. 396 (23.8 %) were collections from 158 patients who did not have need of high dose therapy at the time but in whom the potential need in the future existed. The majority of collections were from patients with Non Hodgkin Lymphoma (NHL) (34%) and Multiple Myeloma (MM) (27%). Only 69 (21%) of collections have been used, the rest remain stored. Collections from MM patients were the most frequently used (34.3%), followed by Hodgkin’s Disease (HD) and acute myeloid and chronic myeloid leukaemia (AML, CML), Only 8% of the collections from NHL patients have been used, the last infusion dating from 1995.

Conclusion: The regular, systematic collection of back-up harvests for all patients in remission is common practice. For patients with MM there is good evidence that this provides increased treatment options and is of value. The low percentage of collections subsequently used in NHL does not justify the cost or resources required and this practice should be reviewed.