An algorithm for utilizing peripheral blood CD34 count as a predictor of the need for plerixafor in autologous stem cell mobilization—cost‐effectiveness analysis

Abstract

Certain patients who receive granulocyte colony-stimulating factor (GCSF) for autologous hematopoietic stem cell (AHSC) collection fail to mobilize well enough to proceed with transplant. When plerixafor is used with GCSF, the likelihood of achieving the CD34⁺ stem cell target in fewer collections is higher; plerixafor use in all patients is unlikely to be cost-effective. This study retrospectively evaluated the effectiveness of utilizing a peripheral blood CD34⁺ stem cell count (PBCD34) ≤8/µL on day 4 of GCSF-based AHSC mobilization as a threshold for plerixafor administration, and compared the efficacy of collection and cost analysis using historical controls. All patients in the study cohort reached their CD34⁺ targets in ≤3 collections. Significantly more patients who received plerixafor + GCSF versus GCSF alone reached their CD34⁺ target in one collection (P = 0.045); however, there were no significant differences in the number of collections or in cumulative product yields. The historical cohort had 10.3% mobilization failures; the number of collections per patient needed to reach the target was significantly higher in the historical cohort versus study cohort (P = 0.001) as was the number of patients requiring more than one collection to reach their target (P = 0.023). However, the average cost per patient was also significantly higher in the study cohort (P = 0.025). Further refinement of the algorithm may reduce the difference in cost between the two mobilization strategies.

Plerixafor in poor mobilizers with non-Hodgkin’s lymphoma: a multi-center time-motion analysis

“…Whether plerixafor is cost-effective depends on the selected perspective, as well as on fees and procedures, specific to each institution [21,[24][25][26]. Studies adopting a wider perspective which captures additional costs incurred to the hospital due to mobilization failure (e.g.…”

Impact of plerixafor (mozobil) on hospital efficiency: A single center experience

“…An increase in the average number of CD34+ cell collection was also reported in other studies: Micallef et al reported an increase in the median CD34+ cell collection from 5.6 × 10 6 CD34+/kg without plerixafor to 7.8 × 10 6 CD34+/kg with plerixafor . On the other hand, Abusin et al reported no statistically significant difference between the final CD34+ cumulative yield between two cohorts treated prior or after plerixafor introduction . Such differences could be due to different treatment algorithm, apheresis procedures, or differences in underlying disease distributions.…”

“…Several studies have published results regarding the additional cost related to the use of plerixafor under different protocols. These costs depend on local fees and prices as well as the perspective adopted in the costing analysis; however, most studies concluded that the use of plerixafor led to an additional but acceptable cost, given the clinical benefit obtained . Micallef et al reported a higher variability in costs in patients treated with G‐CSF only.…”

Evaluating the use of plerixafor in stem cell mobilisation – an economic analysis of thePHANTASTICtrial

“…It was not possible to assess the extent to which plerixafor might have altered clinical outcome or not (e.g., overall or relapse free survival), since patients were not routinely followed beyond 12 months after their transplant. The analysis is therefore a cost‐effectiveness study (cost per patient achieving a stem cell yield sufficient to support a subsequent transplant), and contributes to the increasing evidence about the cost‐effectiveness of plerixafor in myeloma and lymphoma patients .…”