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Hematopoietic Cell Collection

Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study

Bone Marrow Transplantation volume 51, pages 546–552 (2016)Cite this article

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Abstract

Cyclophosphamide plus G-CSF (C+G-CSF) is one of the most widely used stem cell (SC) mobilization regimens for patients with multiple myeloma (MM). Plerixafor plus G-CSF (P+G-CSF) has demonstrated superior SC mobilization efficacy when compared with G-CSF alone and has been shown to rescue patients who fail mobilization with G-CSF or C+G-CSF. Despite the proven efficacy of P+G-CSF in upfront SC mobilization, its use has been limited, mostly due to concerns of high price of the drug. However, a comprehensive comparison of the efficacy and cost effectiveness of SC mobilization using C+G-CSF versus P+G-CSF is not available. In this study, we compared 111 patients receiving C+G-CSF to 112 patients receiving P+G-CSF. The use of P+G-CSF was associated with a higher success rate of SC collection defined as ⩾5 × 106 CD34+ cells/kg (94 versus 83%, P=0.013) and less toxicities. Thirteen patients in the C+G-CSF arm were hospitalized owing to complications while none in the P+G-CSF group. C+G-CSF was associated with higher financial burden as assessed using institutional-specific costs and charges (P<0.001) as well as using Medicare reimbursement rates (P=0.27). Higher rate of hospitalization, increased need for salvage mobilization, and increased G-CSF use account for these differences.

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References

  1. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.

    Article  CAS  Google Scholar 

  2. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  Google Scholar 

  3. Pusic I, Jiang SY, Landua S, Uy GL, Rettig MP, Cashen AF et al. Impact of mobilization and remobilization strategies on achieving sufficient stem cell yields for autologous transplantation. Biol Blood Marrow Transplant 2008; 14: 1045–1056.

    Article  CAS  Google Scholar 

  4. Wuchter P, Ran D, Bruckner T, Schmitt T, Witzens-Harig M, Neben K et al. Poor mobilization of hematopoietic stem cells-definitions, incidence, risk factors, and impact on outcome of autologous transplantation. Biol Blood Marrow Transplant 2010; 16: 490–499.

    Article  CAS  Google Scholar 

  5. Milone G, Martino M, Spadaro A, Leotta S, Di Marco A, Scalzulli P et al. Plerixafor on-demand combined with chemotherapy and granulocyte colony-stimulating factor: significant improvement in peripheral blood stem cells mobilization and harvest with no increase in costs. Br J Haematol 2014; 164: 113–123.

    Article  CAS  Google Scholar 

  6. Ozsan GH, Micallef IN, Dispenzieri A, Kumar S, Lacy MQ, Dingli D et al. Hematopoietic recovery kinetics predicts for poor CD34+ cell mobilization after cyclophosphamide chemotherapy in multiple myeloma. Am J Hematol 2012; 87: 1–4.

    Article  CAS  Google Scholar 

  7. Kumar S, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Gastineau DA et al. Impact of lenalidomide therapy on stem cell mobilization and engraftment post-peripheral blood stem cell transplantation in patients with newly diagnosed myeloma. Leukemia 2007; 21: 2035–2042.

    Article  CAS  Google Scholar 

  8. Mazumder A, Kaufman J, Niesvizky R, Lonial S, Vesole D, Jagannath S . Effect of lenalidomide therapy on mobilization of peripheral blood stem cells in previously untreated multiple myeloma patients. Leukemia 2008; 22: 1280–1281.

    Article  CAS  Google Scholar 

  9. Paripati H, Stewart AK, Cabou S, Dueck A, Zepeda VJ, Pirooz N et al. Compromised stem cell mobilization following induction therapy with lenalidomide in myeloma. Leukemia 2008; 22: 1282–1284.

    Article  CAS  Google Scholar 

  10. Popat U, Saliba R, Thandi R, Hosing C, Qazilbash M, Anderlini P et al. Impairment of filgrastim-induced stem cell mobilization after prior lenalidomide in patients with multiple myeloma. Biol Blood Marrow Transplant 2009; 15: 718–723.

    Article  Google Scholar 

  11. Kumar S, Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W et al. Mobilization in myeloma revisited: IMWG consensus perspectives on stem cell collection following initial therapy with thalidomide-, lenalidomide-, or bortezomib-containing regimens. Blood 2009; 114: 1729–1735.

    Article  CAS  Google Scholar 

  12. Broxmeyer HE, Orschell CM, Clapp DW, Hangoc G, Cooper S, Plett PA et al. Rapid mobilization of murine and human hematopoietic stem and progenitor cells with AMD3100, a CXCR4 antagonist. J Exp Med 2005; 201: 1307–1318.

    Article  CAS  Google Scholar 

  13. DiPersio JF, Micallef IN, Stiff PJ, Bolwell BJ, Maziarz RT, Jacobsen E et al. Phase III prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin's lymphoma. J Clin Oncol 2009; 27: 4767–4773.

    Article  CAS  Google Scholar 

  14. DiPersio JF, Stadtmauer EA, Nademanee A, Micallef IN, Stiff PJ, Kaufman JL et al. Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma. Blood 2009; 113: 5720–5726.

    CAS  Google Scholar 

  15. Calandra G, McCarty J, McGuirk J, Tricot G, Crocker SA, Badel K et al. AMD3100 plus G-CSF can successfully mobilize CD34+ cells from non-Hodgkin's lymphoma, Hodgkin's disease and multiple myeloma patients previously failing mobilization with chemotherapy and/or cytokine treatment: compassionate use data. Bone Marrow Transplant 2008; 41: 331–338.

    Article  CAS  Google Scholar 

  16. Fowler CJ, Dunn A, Hayes-Lattin B, Hansen K, Hansen L, Lanier K et al. Rescue from failed growth factor and/or chemotherapy HSC mobilization with G-CSF and plerixafor (AMD3100): an institutional experience. Bone Marrow Transplant 2009; 43: 909–917.

    Article  CAS  Google Scholar 

  17. Micallef IN, Stiff PJ, DiPersio JF, Maziarz RT, McCarty JM, Bridger G et al. Successful stem cell remobilization using plerixafor (mozobil) plus granulocyte colony-stimulating factor in patients with non-hodgkin lymphoma: results from the plerixafor NHL phase 3 study rescue protocol. Biol Blood Marrow Transplant 2009; 15: 1578–1586.

    Article  CAS  Google Scholar 

  18. Duarte RF, Shaw BE, Marin P, Kottaridis P, Ortiz M, Morante C et al. Plerixafor plus granulocyte CSF can mobilize hematopoietic stem cells from multiple myeloma and lymphoma patients failing previous mobilization attempts: EU compassionate use data. Bone Marrow Transplant 2011; 46: 52–58.

    Article  CAS  Google Scholar 

  19. Hubel K, Fresen MM, Apperley JF, Basak GW, Douglas KW, Gabriel IH et al. European data on stem cell mobilization with plerixafor in non-Hodgkin's lymphoma, Hodgkin's lymphoma and multiple myeloma patients. A subgroup analysis of the European Consortium of stem cell mobilization. Bone Marrow Transplant 2012; 47: 1046–1050.

    Article  CAS  Google Scholar 

  20. Costa LJ, Abbas J, Hogan KR, Kramer C, McDonald K, Butcher CD et al. Growth factor plus preemptive ('just-in-time') plerixafor successfully mobilizes hematopoietic stem cells in multiple myeloma patients despite prior lenalidomide exposure. Bone Marrow Transplant 2012; 47: 1403–1408.

    Article  CAS  Google Scholar 

  21. Jantunen E, Kuittinen T, Mahlamaki E, Pyorala M, Mantymaa P, Nousiainen T . Efficacy of pre-emptively used plerixafor in patients mobilizing poorly after chemomobilization: a single centre experience. Eur J Haematol 2011; 86: 299–304.

    Article  CAS  Google Scholar 

  22. D'Addio A, Curti A, Worel N, Douglas K, Motta MR, Rizzi S et al. The addition of plerixafor is safe and allows adequate PBSC collection in multiple myeloma and lymphoma patients poor mobilizers after chemotherapy and G-CSF. Bone Marrow Transplant 2011; 46: 356–363.

    Article  CAS  Google Scholar 

  23. Attolico I, Pavone V, Ostuni A, Rossini B, Musso M, Crescimanno A et al. Plerixafor added to chemotherapy plus G-CSF is safe and allows adequate PBSC collection in predicted poor mobilizer patients with multiple myeloma or lymphoma. Biol Blood Marrow Transplant 2012; 18: 241–249.

    Article  CAS  Google Scholar 

  24. Smith VR, Popat U, Ciurea S, Nieto Y, Anderlini P, Rondon G et al. Just-in-time rescue plerixafor in combination with chemotherapy and granulocyte-colony stimulating factor for peripheral blood progenitor cell mobilization. Am J Hematol 2013; 88: 754–757.

    Article  CAS  Google Scholar 

  25. Gertz MA, Kumar SK, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK et al. Comparison of high-dose CY and growth factor with growth factor alone for mobilization of stem cells for transplantation in patients with multiple myeloma. Bone Marrow Transplant 2009; 43: 619–625.

    Article  CAS  Google Scholar 

  26. Meldgaard Knudsen L, Jensen L, Gaarsdal E, Nikolaisen K, Johnsen HE . A comparative study of sequential priming and mobilisation of progenitor cells with rhG-CSF alone and high-dose cyclophosphamide plus rhG-CSF. Bone Marrow Transplant 2000; 26: 717–722.

    Article  CAS  Google Scholar 

  27. Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH . Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106: 2258–2266.

    Article  Google Scholar 

  28. Pozotrigo M, Adel N, Landau H, Lesokhin A, Lendvai N, Chung DJ et al. Factors impacting stem cell mobilization failure rate and efficiency in multiple myeloma in the era of novel therapies: experience at Memorial Sloan Kettering Cancer Center. Bone Marrow Transplant 2013; 48: 1033–1039.

    Article  CAS  Google Scholar 

  29. Shaughnessy P, Islas-Ohlmayer M, Murphy J, Hougham M, MacPherson J, Winkler K et al. Cost and clinical analysis of autologous hematopoietic stem cell mobilization with G-CSF and plerixafor compared to G-CSF and cyclophosphamide. Biol Blood Marrow Transplant 2011; 17: 729–736.

    Article  CAS  Google Scholar 

  30. Costa LJ, Miller AN, Alexander ET, Hogan KR, Shabbir M, Schaub C et al. Growth factor and patient-adapted use of plerixafor is superior to CY and growth factor for autologous hematopoietic stem cells mobilization. Bone Marrow Transplant 2011; 46: 523–528.

    Article  CAS  Google Scholar 

  31. Awan F, Kochuparambil ST, Falconer DE, Cumpston A, Leadmon S, Watkins K et al. Comparable efficacy and lower cost of PBSC mobilization with intermediate-dose cyclophosphamide and G-CSF compared with plerixafor and G-CSF in patients with multiple myeloma treated with novel therapies. Bone Marrow Transplant 2013; 48: 1279–1284.

    Article  CAS  Google Scholar 

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Acknowledgements

The MSK Cancer Center Support Grant/Core Grant (P30 CA008748). SA and HH designed the study, collected and analyzed the data and wrote the manuscript. SA, NGA and ED collected the data. SD, JV and ED analyzed the data and assisted in manuscript preparation. SA and HH did not receive any research funding for this research.

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Authors and Affiliations

  1. Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    S Afifi & N G Adel

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    S Afifi, N G Adel, S Devlin, E Duck, J Vanak, H Landau, D J Chung, N Lendvai, A Lesokhin, N Korde, L Reich, O Landgren, S Giralt & H Hassoun

  3. Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    S Devlin

  4. Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    E Duck & J Vanak

  5. Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    H Landau, D J Chung, N Lendvai, A Lesokhin, N Korde, L Reich, O Landgren, S Giralt & H Hassoun

  6. Weill Cornell Medical College, New York, NY, USA

    H Landau, D J Chung, N Lendvai, A Lesokhin, N Korde, L Reich, O Landgren, S Giralt & H Hassoun

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  1. S Afifi
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Correspondence to H Hassoun.

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Additional information

Prior presentation of data: American Society of Hematology (ASH) Meeting 2014 Abstract 848; San Francisco, CA.

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Afifi, S., Adel, N., Devlin, S. et al. Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study. Bone Marrow Transplant 51, 546–552 (2016). https://doi.org/10.1038/bmt.2015.322

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