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

Dhakal, Binod; D’Souza, Anita; Arce-Lara, Carlos; Pasquini, Marcelo C.; Saber, Wael; Falvo, F.; Esselman, Jean; Zellner, Katie R.; Fenske, Timothy S.; Hari, Parameswaran; Hamadani, Mehdi

doi:10.1038/bmt.2014.318

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…The cost of first HPC mobilization attempt (including cost of all medications, laboratory assessments, intravenous access, apheresis, cryopreservation, etc.) was estimated using a method previously described [10,12,19,20]. Costs were calculated per patient in the 3 groups, including all reimbursable procedures and costs of all medications during mobilization.…”

Section: Cost Determinationmentioning

confidence: 99%

Hematopoietic Progenitor Cell Mobilization with Ifosfamide, Carboplatin, and Etoposide Chemotherapy versus Plerixafor-Based Strategies in Patients with Hodgkin and Non-Hodgkin Lymphoma

Dhakal

Veltri

Fenske

et al. 2016

Biology of Blood and Marrow Transplantation

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Studies comparing the efficacy and safety of chemo-mobilization with ifosfamide, carboplatin, and etoposide (ICE) ± rituximab with plerixafor-based approaches in lymphoma patients have not been performed. We analyzed hematopoietic progenitor cell mobilization outcomes in lymphoma patients undergoing chemo-mobilization with ICE (n = 35) compared with either routine plerixafor (n = 30) or "just in time" (JIT) plerixafor-based mobilization (n = 33). Chemo-mobilization provided a significantly higher total CD34(+) cell yield (median collection, 5.35 × 10(6) cells/kg for ICE versus 3.15 × 10(6) cells/kg for routine plerixafor and 3.6 × 10(6) cells/kg for JIT plerixafor, P < .001). The median day 1 yield of CD34(+) cells was not significantly different (median, 2.2 × 10(6) cells/kg in ICE versus 1.9 × 10(6) cells/kg in upfront plerixafor versus 1.7 × 10(6) cells/kg in JIT plerixafor, P = .20). There was no significant difference in the 3 groups in terms of total number of apheresis sessions performed (median, 2 in each group; P = .78). There were no mobilization failures (inability to collect at least 2 × 10(6) cells/kg) in the chemo-mobilization group, whereas 5 patients (16.7%) in the routine plerixafor and 3 patients (9.1%) in JIT group had mobilization failure (P = .04). Mean time to neutrophil engraftment was faster in the chemo-mobilization group, 10.3 days (±1.2) compared with 12.1 days (±3.6) in the routine plerixafor group and 11.6 days (±3.0) in the JIT group (P < .001) and mean time to platelet engraftment was 13.7 days (±.7) in ICE versus 20.3 days (±1.6) in routine plerixafor versus 17.1 days (± .9) in JIT group (P < .001). Red blood cell transfusions were significantly higher in the chemo-mobilization group (34.3% versus 0 versus 3.2% versus 1, P < .001) and so were the platelet transfusions (22.9% versus 0 versus 0, P < .001). Excluding the cost of chemotherapy administration, chemo-mobilization was associated with significantly less mobilization cost (average cost $17,601.76 in ICE versus $28,963.05 in routine and $25,679.81 in JIT, P < .001). Our data suggests that chemo-mobilization with ICE provides a higher total CD34(+) cell yield, lower rates of mobilization failure, faster engraftment, and lower cost compared to plerixafor-based approaches with comparable toxicity profile between the groups, except for higher transfusion requirements with chemo-mobilization.

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Section: Cost Determinationmentioning

confidence: 99%

Hematopoietic Progenitor Cell Mobilization with Ifosfamide, Carboplatin, and Etoposide Chemotherapy versus Plerixafor-Based Strategies in Patients with Hodgkin and Non-Hodgkin Lymphoma

Dhakal

Veltri

Fenske

et al. 2016

Biology of Blood and Marrow Transplantation

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“…Increased HPC mobilization costs are always a concern with the addition of plerixafor, and is one reason for its restricted use globally. Our own previous analysis showed that the addition of plerixafor increased costs in this setting . In other settings, however, plerixafor usage has demonstrated significant reduction in mobilization failure rates, days of apheresis, use of transfusion resources, and rates of inpatient mobilizations .…”

Section: Discussionmentioning

confidence: 99%

“…Our own previous analysis showed that the addition of plerixafor increased costs in this setting. 25 In other settings, however, plerixafor usage has demonstrated significant reduction in mobilization failure rates, days of apheresis, use of transfusion resources, and rates of inpatient mobilizations. 11 In addition, given the safety and efficacy data, despite the additional cost, we have continued with this institutional approach in our AL amyloidosis patients.…”

Section: Discussionmentioning

confidence: 99%

An updated single center experience with plerixafor and granulocyte colony‐stimulating factor for stem cell mobilization in light chain amyloidosis

Badar

Dhakal

Szabó

et al. 2019

J of Clinical Apheresis

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The use of granulocyte‐colony stimulating factor (G‐CSF) with or without chemotherapy to mobilize hematopoietic progenitor cells (HPCs) can result in significant morbidity in light chain (AL) amyloidosis patients. Plerixafor, a strong inducer and mobilizer of HPCs, can be used as an adjunct to G‐CSF to improve mobilization efficiency. We describe the outcomes for combined G‐CSF/plerixafor mobilized patients with AL amyloidosis. We reviewed data of 53 consecutive AL amyloidosis patients who underwent combined G‐CSF/plerixafor HPC mobilization between May 2011 and October 2017 at our institution. We evaluated patients for HPC collection efficiency, perimobilization toxicity and postautologous hematopoietic cell transplantation (autoHCT) outcomes. Median CD34+ cell collection was 12.4 × 106 cells/kg (range 2.5 × 106 to 34.1 × 106 cells/kg) and 45 (85%) patients had collections of ≥5.0 × 106 CD34+ cells/kg. There were no mobilization failures or perimobilization mortality. During mobilization, 37 (70%) patients had weight gain (median 1.3 kg, range 0.1‐4) but none >10% body weight, 5 (10%) patients had diarrhea, and one patient each had hypotension and cardiac arrhythmia. Among the 31 patients analyzed for CD34 collection efficiency (CE), the median CD34 CE was 47% (range 36‐62). At 5 years follow‐up 82% and 84% of patients were progression‐free and alive, respectively. Our results suggest that G‐CSF/plerixafor mobilization is safe, well tolerated, and effective in AL amyloidosis.

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“…Estimates of mobilization failure with standard G‐CSF regimens range from 10% to 40% of cases, which provided the impetus for newer agents such as the CXCR4 inhibitor plerixafor and more recently VLA‐4 inhibitors and the proteasome inhibitor bortezomib . While plerixafor is highly effective at mobilizing stem cells, it remains costly (potentially exceeding $6000 per dose), and its use is complicated by a short half‐life of approximately 3.6 hours with a maximum effect between 6 to 9 hours after subcutaneous injection . These time restraints necessitate rapid and accurate HSC quantification for optimal and cost‐effective use.…”

mentioning

confidence: 99%

Rapid prediction of stem cell mobilization using volume and conductivity data from automated hematology analyzers

et al. 2017

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

Cited by 6 publications

References 15 publications

Hematopoietic Progenitor Cell Mobilization with Ifosfamide, Carboplatin, and Etoposide Chemotherapy versus Plerixafor-Based Strategies in Patients with Hodgkin and Non-Hodgkin Lymphoma

Hematopoietic Progenitor Cell Mobilization with Ifosfamide, Carboplatin, and Etoposide Chemotherapy versus Plerixafor-Based Strategies in Patients with Hodgkin and Non-Hodgkin Lymphoma

An updated single center experience with plerixafor and granulocyte colony‐stimulating factor for stem cell mobilization in light chain amyloidosis

Rapid prediction of stem cell mobilization using volume and conductivity data from automated hematology analyzers

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