Matched-pair analysis of hematopoietic progenitor cell mobilization using G-CSF vs. cyclophosphamide, etoposide, and G-CSF: Enhanced CD34+ cell collections are not necessarily cost-effective

AbstractUsing matched-pair analysis, we compared two popular methods of stem cell mobilization in 24 advanced-stage breast cancer patients who underwent two consecutive mobilizing procedures as part of a tandem transplant protocol. For the first cycle, 10 microg/kg/day granulocyte colony-stimulating factor (G-CSF) was given and apheresis commenced on day 4 and continued for < or =5 days (median 3 days). One week after the first cycle of apheresis, 4000 mg/m2 cyclophosphamide, 400 mg/m2 etoposide, and 10 microg/kg G-CSF were administered for < or =16 days (cycle 2). Apheresis was initiated when the white blood cell (WBC) count exceeded 5000 cells/microL and continued for < or =5 days (median 3 days). Mean values of peripheral blood WBC (31,700+/-3200 vs. 30,700+/-3300/microL) were not significantly different between cycles 1 and 2. Mean number of mononuclear cells (MNC) collected per day was slightly greater with G-CSF mobilization than with the combination of chemotherapy and G-CSF (2.5+/-0.21x10(8) vs. 1.8+/-0.19x10(8) cells/kg). Mean daily CD34+ cell yield, however, was nearly six times higher (12.9+/-4.4 vs. 2.2+/-0.5x10(6)/kg; p = 0.01) with chemotherapy plus G-CSF. With G-CSF alone, 13% of aphereses reached the target dose of 5x10(6) CD34+ cells/kg in one collection vs. 57% with chemotherapy plus G-CSF. Transfusions of red blood cells or platelets were necessary in 18 of 24 patients in cycle 2. Three patients were hospitalized with fever for a median of 3 days after cycle 2. No patients received transfusions or required hospitalization during mobilization with G-CSF alone. Resource utilization (cost of drugs, aphereses, cryopreservation, transfusions, hospitalization) was calculated comparing the median number of collections to obtain a target CD34+ cell dose of 5x10(6) cells/kg: four using G-CSF vs. one using the combination in this data set. Resources for G-CSF mobilization cost $7326 vs.$8693 for the combination, even though more apheresis procedures were performed using G-CSF mobilization. The cost of chemotherapy administration, more doses of G-CSF, transfusions, and hospitalizations caused cyclophosphamide, etoposide, and G-CSF to be more expensive than G-CSF alone. A less toxic and less expensive treatment than cyclophosphamide, etoposide, and G-CSF is needed to be more cost-effective than G-CSF alone for peripheral blood progenitor cell mobilization.Biol Blood Marrow Transplant 1999;5(6):379-85

Interference of spoken word recognition through phonological priming from visual objects and printed words

Item does not contain fulltextThree cross-modal priming experiments examined the influence of preexposure to pictures and printed words on the speed of spoken word recognition. Targets for auditory lexical decision were spoken Dutch words and nonwords, presented in isolation (Experiments 1 and 2) or after a short phrase (Experiment 3). Auditory stimuli were preceded by primes, which were pictures (Experiments 1 and 3) or those pictures' printed names (Experiment 2). Prime-target pairs were phonologically onset related (e.g., pijl-pijn, arrow-pain), were from the same semantic category (e.g., pijl-zwaard, arrow-sword), or were unrelated on both dimensions. Phonological interference and semantic facilitation were observed in all experiments. Priming magnitude was similar for pictures and printed words and did not vary with picture viewing time or number of pictures in the display (either one or four). These effects arose even though participants were not explicitly instructed to name the pictures and where strategic naming would interfere with lexical decision making. This suggests that, by default, processing of related pictures and printed words influences how quickly we recognize spoken words.11 p