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Autografting

Outcome, toxicity profile and cost analysis of autologous stem cell mobilization

Abstract

Autologous stem cell mobilization (ASCM) is conventionally done using high-dose CY plus granulocyte colony-stimulating factor (G). It is important to examine the outcomes, toxicity profile and costs of ASCM associated with CY+G. A retrospective study was conducted in 236 patients with myeloma or lymphoma undergoing ASCM with CY+G. An ideal outcome was defined as 2 × 106 CD34+ cells/kg collected on the planned day of collection in 1 or 2 apheresis without a negative clinical event. The total cost of ASCM including clinical events, were reported based on Medicare part-B physician, laboratory and ancillary fee schedule. ASCM was successful in 213 (90%) patients, but an ideal outcome was seen in only 50 (20%) patients. Median (interquartile range, IQR) total cost of CY+G stem cells mobilization was $10 605 ($9230–$14 540). Ideal outcomes were associated with lower costs compared with non-ideal outcomes (median (IQR), $9914 ($8743–$11 168) versus $11232 ($9292–$15 518) respectively, P<0.001). The median (IQR) cost of non-ideal outcome was higher among lymphoma patients ($12 293 ($9578–$16 268)) compared with myeloma patients ($10 388 ($9355–$14 360) (P=0.04). Although mobilization success is eventually realized with CY+G, it has a low rate of ideal outcome, associated with significant adverse events and costs.

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References

  1. Bensinger W, DiPersio JF, McCarty JM . Improving stem cell mobilization strategies: future directions. Bone Marrow Transplant 2009; 43: 181–195.

    Article  CAS  PubMed  Google Scholar 

  2. Moskowitz CH, Glassman JR, Wuest D, Maslak P, Reich L, Gucciardo A et al. Factors affecting mobilization of peripheral blood progenitor cells in patients with lymphoma. Clin Cancer Res 1998; 4: 311–316.

    CAS  PubMed  Google Scholar 

  3. Ashihara E, Shimazaki C, Okano A, Hatsuse M, Okamoto A, Shimura K et al. Infusion of a high number of CD34+ cells provides a rapid hematopoietic recovery and cost savings in autologous peripheral blood stem cell transplantation. Jpn J Clin Oncol 2002; 32: 135–139.

    Article  PubMed  Google Scholar 

  4. Schulman KA, Birch R, Zhen B, Pania N, Weaver CH . Effect of CD34(+) cell dose on resource utilization in patients after high-dose chemotherapy with peripheral-blood stem-cell support. J Clin Oncol 1999; 17: 1227.

    Article  CAS  PubMed  Google Scholar 

  5. Meehan KR, Hill JM, Patchett L, Webber SM, Wu J, Ely P et al. Implementation of peripheral blood CD34 analyses to initiate leukapheresis: marked reduction in resource utilization. Transfusion 2006; 46: 523–529.

    Article  PubMed  Google Scholar 

  6. Gertz MA, Wolf RC, Micallef IN, Gastineau DA . Clinical impact and resource utilization after stem cell mobilization failure in patients with multiple myeloma and lymphoma. Bone Marrow Transplant 2010; 45: 1396–1403.

    Article  CAS  PubMed  Google Scholar 

  7. Vose JM, Ho AD, Coiffier B, Corradini P, Khouri I, Sureda A et al. Advances in mobilization for the optimization of autologous stem cell transplantation. Leuk Lymphoma 2009; 50: 1412–1421.

    Article  CAS  PubMed  Google Scholar 

  8. 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  PubMed  Google Scholar 

  9. 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  PubMed  Google Scholar 

  10. Tricot G, Cottler-Fox MH, Calandra G . Safety and efficacy assessment of plerixafor in patients with multiple myeloma proven or predicted to be poor mobilizers, including assessment of tumor cell mobilization. Bone Marrow Transplant 2010; 45: 63–68.

    Article  CAS  PubMed  Google Scholar 

  11. Nazha A, Cook R, Vogl D, Mangan P, Hummel K, Cunningham K et al. Plerixafor and G-CSF Versus Cyclophosphamide and G-CSF for Stem Cell Mobilization in Patients with Multiple Myeloma. Blood 2009; 114: abstract 844.

    Article  Google Scholar 

  12. Shaughnessy P, Islas-Ohlamayer M, Murphy J, Houghman M, MacPherson J, Winkler K et al. Plerixafor Plus G-CSF Compared to Chemotherapy Plus G-CSF for Mobilization of Autologous CD34+ Cells Resulted in Similar Cost but More Predictable Days of Apheresis and Less Hospitalization. Blood 2009; 114: abstract 897.

    Google Scholar 

  13. Campen C, Armstrong E, Christian J, Hadeed S, Yeager A . Comparative Cost-effectiveness of prelixafor plus granulocyte-colony stimulating factor versus cyclophosphamide plus granulocyte-colony stimulating factor for autologous peripheral blood stem cell mobilization in patients with non-hodgkin's lymphoma. Biol Blood Marrow Transplant 2010; 16: s206.

    Article  Google Scholar 

  14. Jantunen E, Putkonen M, Nousiainen T, Pelliniemi TT, Mahlamaki E, Remes K . Low-dose or intermediate-dose cyclophosphamide plus granulocyte colony-stimulating factor for progenitor cell mobilisation in patients with multiple myeloma. Bone Marrow Transplant 2003; 31: 347–351.

    Article  CAS  PubMed  Google Scholar 

  15. Fitoussi O, Perreau V, Boiron JM, Bouzigon E, Cony-Makhoul P, Pigneux A et al. A comparison of toxicity following two different doses of cyclophosphamide for mobilization of peripheral blood progenitor cells in 116 multiple myeloma patients. Bone Marrow Transplant 2001; 27: 837–842.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Genzyme provided financial support for Dr Jagasia (research grant) and Dr Pickard (consultant).

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Correspondence to M H Jagasia.

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Jagasia, M., Savani, B., Neff, A. et al. Outcome, toxicity profile and cost analysis of autologous stem cell mobilization. Bone Marrow Transplant 46, 1084–1088 (2011). https://doi.org/10.1038/bmt.2010.254

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