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Cost and efficacy of peripheral stem cell mobilization strategies in multiple myeloma

Bone Marrow Transplantation volume 55, pages 2254–2260 (2020)Cite this article

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Abstract

Mobilization of peripheral blood stem cells (PBSC) can be performed using plerixafor, which is expensive, or high-dose cyclophosphamide (HDCy). We hypothesized that the overall cost of mobilization with plerixafor might not be greater if the cost of complication management was considered. We performed a cost analysis of these two strategies. This multicentric observational study recruited patients with myeloma who underwent a first PBSC mobilization. We considered direct medical costs, including hospitalization, mobilization agents, apheresis, and supportive treatments. We included 111 patients, 54 and 57 in the HDCy and plerixafor groups, respectively. Cost of mobilization with HDCy was 5097 ± 2982€ vs. 10958 ± 1789€ for plerixafor (p < 0.0001). Cost of agents used was 1287 ± 779€ vs. 6552 ± 509€, respectively (p = 0.0009). The mean number of days of hospitalization was 2 and 2.1 days, respectively (p = 0.035). All patients achieved the minimum PBSC collection target (p = 1.0); however, ASCT was performed with HDCy in 67% patients and with plerixafor in 86% (p = 0.02). Plerixafor mobilization incurred a greater cost, mostly due to the greater cost of the drug. Hospitalization length in the two groups was similar in our series. Interestingly, plerixafor appeared to be a very effective and safe mobilizing approach translating into a greater ASCT success.

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Acknowledgements

Data management was performed by AXONAL. Authors would like to thank the IFM staff, the centers, patients and their families, and Peter Jenkinson for English editing.

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Author notes

  1. These authors contributed equally: Zoé Van de Wyngaert, Virginie Nerich, Samuel Limat, Xavier Leleu

Authors and Affiliations

  1. CHU Lille, Service des Maladies du Sang, F-59000, Lille, France

    Zoé Van de Wyngaert

  2. Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France

    Zoé Van de Wyngaert, Laurent Garderet & Ramdane Belhocine

  3. Department of Pharmacy, University Hospital of Besançon, Univ. Bourgogne Franche-Comté, Besançon, France

    Virginie Nerich & Samuel Limat

  4. INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France

    Virginie Nerich & Samuel Limat

  5. Institut Imagine, Inserm U1163, Hôpital Necker, APHP, Paris, France

    Guillemette Fouquet

  6. Department of Hematology, CHU, Dijon, France

    Marie-Lorraine Chrétien & Denis Caillot

  7. Hôpital Pitié Salpêtrière, Service d’Hématologie, F-75013, Paris, France

    Nabih Azar & Laurent Garderet

  8. Centre Henri Becquerel, Rouen, France

    Pascal Lenain

  9. Institut d’hématologie, CHU, Caen, France

    Margaret Macro

  10. Department of Hématologie, Institut Gustave Roussy, Villejuif, France

    Jean-Henri Bourhis

  11. Hématologie clinique et thérapie cellulaire, CHU, Limoges, France

    Arnaud Jaccard

  12. Service d’Hématologie, Hospices Civils de Lyon, Lyon Sud, France

    Lionel Karlin

  13. Hematology and Inserm CIC 1402, CHU, Poitiers, France

    Arthur Bobin, Niels Moya, Thomas Systchenko, Cecile Gruchet, Christine Giraud, Stéphanie Guidez, Claire Darras, Isabelle Princet & Xavier Leleu

  14. Hematology Department, University Hospital Hotel-Dieu, Nantes, France

    Cyrille Touzeau & Philippe Moreau

  15. Department of Hematology, CHU, Bordeaux, France

    Cyrille Hulin

  16. Department of Hematology, CHU, Besançon, France

    Erik Deconinck

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Consortia

On behalf of IFM (Intergroupe Français du Myélome – IFM 2014-05)

Contributions

Conception and design: XL, DC, ED, SL, ZVDW. Conduction of Trial: XL, DC, ED, SL. Collection and assembly of data: MLC, DC, NA LG, PL, MM, JHB, RB, AJ, LK, AB, NM, TS, CG, CG, SG, CD, IP, CT, PM, CH, ED. Data analysis and interpretation: SL, VN. Paper writing: ZVDW, GF, XL, DC, ED, SL, VN.

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Correspondence to Xavier Leleu.

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Conflict of interest

LK, PM, CH have no relevant conflict of interest to disclose. XL declares honorarium from Sanofi. ZVDW, VN, GF, MLC, DC, NA, LG, PL, MM, JHB, RB, AJ, AB, NM, TS, CGr, CGi, SG, CD, IP, CT, ED, SL have nothing to disclose.

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Van de Wyngaert, Z., Nerich, V., Fouquet, G. et al. Cost and efficacy of peripheral stem cell mobilization strategies in multiple myeloma. Bone Marrow Transplant 55, 2254–2260 (2020). https://doi.org/10.1038/s41409-020-0940-3

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