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Autografting

Outcomes and costs of autologous stem cell mobilization with chemotherapy plus G-CSF vs G-CSF alone

Bone Marrow Transplantation volume 48, pages 1444–1449 (2013)Cite this article

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Abstract

Chemotherapy plus G-CSF (C+G) and G-CSF alone are two of the most common methods used to mobilize CD34+ cells for autologous hematopoietic SCT (AHSCT). In order to compare and determine the real-world outcomes and costs of these strategies, we performed a retrospective study of 226 consecutive patients at 11 medical centers (64 lymphoma, 162 multiple myeloma), of whom 55% of lymphoma patients and 66% of myeloma patients received C+G. Patients with C+G yielded more CD34+ cells/day than those with G-CSF alone (lymphoma: average 5.51 × 106 cells/kg on day 1 vs 2.92 × 106 cells/kg, P=0.0231; myeloma: 4.16 × 106 vs 3.69 × 106 cells/kg, P<0.00001) and required fewer days of apheresis (lymphoma: average 2.11 vs 2.96 days, P=0.012; myeloma: 2.02 vs 2.83 days, P=0.0015), although nearly all patients ultimately reached the goal of 2 × 106 cells/kg. With the exception of higher rates of febrile neutropenia in myeloma patients with C+G (17% vs 2%, P<0.05), toxicities and other outcomes were similar. Mobilization with C+G cost significantly more (lymphoma: median $10 300 vs $7300, P<0.0001; myeloma: $8800 vs $5600, P<0.0001), although re-mobilization adds $6700 for drugs alone. Our results suggest that although both C+G and G-CSF alone are effective mobilization strategies, C+G may be more cost-effective for patients at high risk of insufficient mobilization.

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Acknowledgements

Dr Sung’s effort was supported by NIH T32 HL007057-37. Dr Holmberg has received research funding from Sanofi/Genzyme, and Dr Shaughnessy has received research funding and honorarium from Sanofi/Genzyme and Millenium.

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No funding was provided for the manuscript development and no author received remuneration for their contributions to the manuscript.

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Authors and Affiliations

  1. Divison of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA

    A D Sung, M E Horwitz, J Kanda & N J Chao

  2. Cornerstone Research Group Inc, Burlington, Ontario, Canada

    D T Grima, L M Bernard & S Brown

  3. Department of Cell and Gene Therapy, Baylor College of Medicine, The Methodist Hospital, Houston, TX, USA

    G Carrum

  4. Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA

    L Holmberg

  5. Department of Medicine and James P. Wilmont Cancer Center, University of Rochester Medical Center, Rochester, NY, USA

    J L Liesveld

  6. Department of Hematology/Oncology, University of Minnesota Medical Center, Minneapolis, MN, USA

    B McClune

  7. Texas Transplant Institute, San Antonio, TX, USA

    P Shaughnessy

  8. Divison of Hematology/Adult Hematopoietic Stem Cell Transplant and Multiple Myeloma Program, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    G J Tricot

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  1. A D Sung
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Correspondence to A D Sung.

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Sung, A., Grima, D., Bernard, L. et al. Outcomes and costs of autologous stem cell mobilization with chemotherapy plus G-CSF vs G-CSF alone. Bone Marrow Transplant 48, 1444–1449 (2013). https://doi.org/10.1038/bmt.2013.80

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  • DOI: https://doi.org/10.1038/bmt.2013.80

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