There are limited data available supporting the use of the recombinant granulocyte colony-stimulating factor (G-CSF), tbo-filgrastim, rather than traditionally used filgrastim to mobilize peripheral blood stem cells (PBSC) or to accelerate engraftment after autologous stem cell transplantation (ASCT). We sought to compare the efficacy and cost of tbo-filgrastim to filgrastim in these settings. Patients diagnosed with lymphoma or plasma cell disorders undergoing G-CSF mobilization, with or without plerixafor, were included in this retrospective analysis. The primary outcome was total collected CD34(+) cells/kg. Secondary mobilization endpoints included peripheral CD34(+) cells/μL on days 4 and 5 of mobilization, adjunctive use of plerixafor, CD34(+) cells/kg collected on day 5, number of collection days and volumes processed, number of collections reaching 5 million CD34(+) cells/kg, and percent reaching target collection goal in 1 day. Secondary engraftment endpoints included time to neutrophil and platelet engraftment, number of blood product transfusions required before engraftment, events of febrile neutropenia, and length of stay. A total of 185 patients were included in the final analysis. Patients receiving filgrastim (n = 86) collected a median of 5.56 × 10(6) CD34(+) cells/kg, compared with a median of 5.85 × 10(6) CD34(+) cells/kg in the tbo-filgrastim group (n = 99; P = .58). There were no statistically significant differences in all secondary endpoints with the exception of apheresis volumes processed (tbo-filgrastim, 17.0 liters versus filgrastim, 19.7 liters; P < .01) and mean platelet transfusions (tbo-filgrastim, 1.7 units versus filgrastim, 1.4 units; P = .04). In conclusion, tbo-filgrastim demonstrated similar CD34(+) yield compared with filgrastim in mobilization and post-transplantation settings, with no clinically meaningful differences in secondary efficacy and safety endpoints. Furthermore, tbo-filgrastim utilization was associated with cost savings of approximately $1406 per patient utilizing average wholesale price.
Background: Autologous hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of developing life-threatening infections. There is discordance in published recommendations for timing of pre-and post-transplant antimicrobial prophylaxis in this patient population, and these recommendations are unsubstantiated by any published comparative analyses.Methods: An observational, pre-and post-intervention study of consecutive autologous HSCT recipients was conducted over a 2-year period. In the pre-intervention cohort, antimicrobial prophylaxis was initiated on the day prior to transplant. In the post-intervention cohort, antimicrobials were initiated once absolute neutrophil count (ANC) reached ≤500 cells/mm 3 . The primary outcome assessed was frequency of febrile occurrences. Secondary outcomes included total days of prophylaxis, positive blood cultures, all-cause mortality, Clostridioides difficile infection rates, and length of stay.Results: A total of 208 patients were included in the final analysis, with 105 and 103 patients in the pre-and post-intervention cohorts, respectively. The majority of patients included were male. Lower rates of fever occurrences were observed in the post-intervention cohort (83% pre-vs. 69% post-intervention; p = 0.019). A significant reduction in the mean antibacterial days per patient was identified (9.7 vs. 4.6 days; p < 0.001). Other than lower rates of febrile neutropenia in the post-intervention cohort, no differences were identified in secondary outcomes. In multivariable analyses, ANC-driven prophylaxis was independently associated with decreased febrile events.Conclusions: Delaying prophylaxis until severe neutropenia was not associated with increased febrile events or other secondary clinical outcomes evaluated. This approach is associated with a significant reduction in antimicrobial exposure.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
(4%). The median cell dose was 5.5 x 10 6 CD34+ cells/kg (range 2.86 to 12.3 x 10 6). No patient died within 100 days of transplant. The median follow up was 27 months (range 1.5 to 79.8). The median overall survival at 1 year, 3 years, and 5 years was 87%, 77%, and 77%. Relapse free survival at 1 year, 3 years, and 5 years was 78%, 68%, and 68%. In conclusion, bortezomib-based therapy followed by ASCT is well tolerated and can be performed with low TRM, resulting in durable OS and RFS.
BackgroundHematopoietic stem cell transplant (HSCT) patients develop profound neutropenia during the transplant process and often fever, which is suggestive of infection. Antimicrobial prophylaxis (AP) during anticipated neutropenia is recommended; however, data regarding when to initiate AP is limited. A local quality improvement initiative adjusted AP initiation to target the duration of severe neutropenia, defined as ANC ≤ 500 mm3 (ANC500), which is when patients are at the greatest risk of infection. This initiative aimed to reduce antimicrobial utilization and consequences of unnecessary antimicrobial exposure while not adversely affecting patient outcomes.MethodsA retrospective study was conducted across two cohorts over a 2-year period. The pre-intervention cohort (November 2016–2017) called for the initiation of AP on Day -1 prior to transplant. The post-intervention cohort (November 2017–2018) called for initiation of AP when patients reached ANC500. The primary outcome was frequency of febrile occurrences (temperature ≥38°C). Secondary outcomes included days of antimicrobial exposure, positive blood cultures, all-cause mortality, length of stay, graft-vs.-host disease, and Clostridioides difficile rates. Patients were excluded if they received a haploidentical transplant or inappropriate AP for the specified cohort.ResultsA total of 248 patients were included in the final analysis with 130 patients in the pre-intervention cohort and 118 patients in the post-intervention cohort. The final analysis included 40 allogeneic and 208 autologous HSCT patients. There was no difference in fever occurrences between the two groups (79% pre vs. 69% post; P = 0.078). There was a significant reduction in the mean antibacterial (10.3 vs. 4.95; P < 0.001) and antifungal (13.4 vs. 7.6; P < 0.001) prophylaxis per patient-days in the pre- and post-intervention group. No significant differences in positive blood cultures (11.5% vs. 16.9%; P = 0.222), ICU admissions, length of stay or all-cause mortality were identified.ConclusionDelaying antimicrobial prophylaxis (AP) until severe neutropenia showed no difference in fever occurrences or other patient outcomes. This approach is associated with a drastic reduction in antimicrobial exposure.Disclosures
All authors: No reported disclosures.
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