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

Abstract

Studies comparing the efficacy and cost of stem cell mobilization with intermediate-dose CY (ID-CY) and G-CSF against plerixafor and G-CSF, specifically in multiple myeloma (MM) patients treated in the novel therapy era, are not available. Eighty-eight consecutive patients undergoing mobilization with ID-CY (3-4 g/m 2 ) and G-CSF (n ¼ 55) were compared with patients receiving plerixafor and G-CSF (n ¼ 33). Compared with plerixafor, ID-CY use was associated with higher median peak peripheral blood CD34 þ cell count (68 vs 160 cells/mL, Po0.001), and CD34 þ cell yield on day 1 of collection (6.9 Â 10 6 vs 11.7 Â 10 6 cells/kg, Po0.001). Total CD34 þ cell yield was significantly higher in the ID-CY patients (median collection 16.6 Â 10 6 vs 11.6 Â 10 6 cells/kg; Po0.001). ID-CY use was associated with significantly more frequent episodes of febrile neutropenia (16.3% vs 0%; P ¼ 0.02), intravenous antibiotic use (16.3% vs 3%; P ¼ 0.03) and hospitalizations (P ¼ 0.02). The average total cost of mobilization in the plerixafor group was significantly higher compared with the ID-CY group ($28 980 vs $22 504.8; P ¼ 0.001). Our data indicate robust stem cell mobilization in MM patients treated with novel agents, with G-CSF and either ID-CY or plerixafor. When compared with plerixafor, ID-CY-containing mobilization was associated with significantly lower average total mobilization costs.

Superior efficacy but higher cost of plerixafor and abbreviated-course G-CSF for mobilizing hematopoietic progenitor cells (HPC) in AL amyloidosis

“…In multiple myeloma, when compared with chemomobilization, plerixafor use appeared to be cost neutral for patients finishing mobilization on day 1 with this benefit disappearing in patients needing two or more sessions. 14,15 In contrast, our study did not show such an effect, with higher costs in the plerixafor group, regardless of the number of total apheresis sessions. This is likely due to the fact that our study compared cost of G+P approach, with a cytokine-only method, unlike prior studies in myeloma and lymphoma where the comparator group was chemotherapy-based mobilization.…”

“…Hospital charges and reimbursements vary depending on transplant center's billing practices and the patient's insurance provider (Medicaid vs Medicare vs private insurance). For our cost analysis, we adopted the previously published methodologies 14,15 to make our analysis applicable to a broader range of transplant programs.…”

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

“…The authors reported a higher CD34+ cell yield on day 1 and higher total yield (16.6 × 10 6 vs 11.6 × 10 6 cells/kg, P o0.001) in the non-plerixafor group, yet more G-CSF usage. 31 In addition, the authors noted that cyclophosphamide was associated with a significantly lower average total cost of mobilization. This latter observation may, at least partially, be attributed to the unusual absence, at odds with all studies, of mobilization failure and subsequent need for salvage mobilization.…”

“…14,30,31 Such high rates of hospitalization, if more representative of other institutions, would result in even higher financial burden in the C+G-CSF group. In addition, more important than financial burden, is the safety and quality of life for patients undergoing SC mobilization.…”

G-CSF plus preemptive plerixafor vs hyperfractionated CY plus G-CSF for autologous stem cell mobilization in multiple myeloma: effectiveness, safety and cost analysis

“…Costa et al 20 showed in a retrospective single institution study that G-CSF with preemptive plerixafor is superior to intermediate-dose CY-based mobilization for autologous hematopoietic stem cell mobilization in terms of safety, efficiency and no difference in mobilization cost. On the other hand, Awan et al 32 compared intermediate-dose CY-based mobilization with G-CSF with preemptive plerixafor and showed a comparable efficacy and lower cost with higher but manageable toxicity in favor of CY strategy. We acknowledge several limitations in our analysis.…”