The Rationale for Performing Autologous Peripheral Blood Stem Cell Transplants in Community Cancer Centers

There is debate over whether or not the technology of peripheral blood stem cell (PBSC) support of high-dose chemotherapy (HDC) should be disseminated to practicing oncologists or continue to be administered only in academic referral centers. High-dose therapy with stem cell support is now the standard of care for selected patients with lymphoma, multiple myeloma and possibly breast cancer. Such therapies, delivered in a clinical trials setting, need to be more widely available to eligible patients. This manuscript presents the rationale for performing HDC with PBSC support in community cancer centers. The availability of PBSC has made the delivery of well-established HDC regimens safe and effective in an outpatient setting. Delivery of such therapy where the patient lives has many economic and social advantages to the patient compared to referral to a transplant center. In addition, more patients can be treated more cost effectively if such therapy is administered locally where the patient lives. From the scientific point of view, improved access to HDC in the community should increase accrual to clinical trials, allowing the generation of outcome data more rapidly.