Toward a More Rational Policy for Autologous Hematopoietic Stem Cell Mobilization

Devine, Steven M.

doi:10.1016/j.bbmt.2012.08.001

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…The concomitant use of plerixafor with G-CSF resulted in improvement in the yield of CD34+ cells compared with G-CSF alone in patients with MM and non-Hodgkin's lymphoma. [26][27][28][29] The safety and efficacy of plerixafor has been proven in several studies, 17,30 which included heavily pretreated patients. 18 Moreover, plerixafor has been shown to be feasible to combine with chemotherapy and G-CSF in predicted poor mobilizers with MM or lymphoma.…”

Section: Discussionmentioning

confidence: 99%

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

Antar

Otrock

Kharfan‐Dabaja

et al. 2015

Bone Marrow Transplant

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The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) remains undefined. We retrospectively compared our experience in hematopoietic cell mobilization in 83 MM patients using fractionated high-dose CY and G-CSF with G-CSF plus preemptive plerixafor. All patients in the CY group (n = 56) received fractionated high-dose CY (5 g/m 2 divided into five doses of 1 g/m 2 every 3 h) with G-CSF. All patients in the plerixafor group (n = 27) received G-CSF and plerixafor preemptively based on an established algorithm. Compared with plerixafor, CY use was associated with higher total CD34+ cell yield (7.5 × 10 6 vs 15.5 × 10 6 cells/kg, P = 0.005). All patients in both groups yielded ⩾ 4 × 10 6 CD34+ cells/kg. Conversely, CY use was associated with high frequency of febrile neutropenia, blood and platelet transfusions need and hospitalizations. The average total cost of mobilization in Lebanon was slightly higher in the plerixafor group ($7886 vs $7536; P = 0.16). Our data indicate robust stem cell mobilization in MM patients with either fractionated high-dose CY and G-CSF or G-CSF alone with preemptive plerixafor. The chemo-mobilization approach was associated with twofold stem cell yield, slightly lower cost but significantly increased toxicity.

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Section: Discussionmentioning

confidence: 99%

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

Antar

Otrock

Kharfan‐Dabaja

et al. 2015

Bone Marrow Transplant

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“…3 If not for its cost, plerixafor would likely enjoy widespread use for PBPC mobilization because it is effective and relatively safe. 6 No prospective studies have compared chemomobilization with plerixafor plus G-CSF. Although a few retrospective studies have compared CY-based mobilization against plerixafor and G-CSF, they used a range of CY doses, 14,15 and included histologies in addition to MM.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] The best PBPC mobilization method in MM is controversial. However, suboptimal collection outcomes in certain subgroups of MM patients (for example, those with prolonged lenalidomide exposure) mobilized with G-CSF alone are well known.…”

Section: Introductionmentioning

confidence: 99%

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

Awan

Kochuparambil

Falconer

et al. 2013

Bone Marrow Transplant

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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.

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“…Superiority of plerixafor plus G‐CSF mobilization over G‐CSF alone in MM has been shown in a phase III trial . If not for its cost, plerixafor would have enjoyed widespread use for PBPC mobilization because it is effective and relatively safe . No prospective studies have compared chemomobilization with plerixafor plus G‐CSF.…”

Section: Discussionmentioning

confidence: 99%

“…The best method for peripheral blood stem and progenitor cell (PBPC) mobilization in MM is controversial. Commonly used strategies for mobilization include; cytokines (e.g., granulocyte‐colony stimulating factor [G‐CSF]), either alone or in combination with myelosuppressive chemotherapy or plerixafor . However, PBPC collection with G‐CSF alone, in certain subgroups of MM patients (e.g., history of prolonged lenalidomide therapy, prior radiotherapy, advanced age, etc.…”

Section: Introductionmentioning

confidence: 99%

Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy‐era with plerixafor and G‐CSF has superior efficacy but significantly higher costs compared to mobilization with low‐dose cyclophosphamide and G‐CSF

Chaudhary

Awan

Cumpston

et al. 2013

J of Clinical Apheresis

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Studies comparing the efficacy and cost of peripheral blood stem and progenitor cells mobilization with low-dose cyclophosphamide (LD-CY) and granulocyte-colony stimulating factor (G-CSF) against plerixafor and G-CSF, in multiple myeloma (MM) patients treated in the novel therapy-era are not available. Herein, we report mobilization outcomes of 107 patients who underwent transplantation within 1-year of starting induction chemotherapy with novel agents. Patients undergoing mobilization with LD-CY (1.5 gm/m(2)) and G-CSF (n = 74) were compared against patients receiving plerixafor and G-CSF (n = 33). Compared to plerixafor, LD-CY was associated with a significantly lower median peak peripheral blood CD34+ cell count (68/µL vs. 36/µL, P = 0.048), and lower CD34+ cell yield on day 1 of collection (6.9 × 10(6)/kg vs. 2.4 × 10(6)/kg, P = 0.001). Six patients (8.1%) in the LD-CY group experienced mobilization failure, compared to none in the plerixafor group. The total CD34+ cell yield was significantly higher in the plerixafor group (median 11.6 × 10(6)/kg vs. 7 × 10(6)/kg; P-value = 0.001). Mobilization with LD-CY was associated with increased (albeit statistically non-significant) episodes of febrile neutropenia (5.4% vs. 0%; P = 0.24), higher use of intravenous antibiotics (6.7% vs. 3%; P = 0.45), and need for hospitalizations (9.4% vs. 3%; P = 0.24). The average total cost of mobilization in the plerixafor group was significantly higher compared to the LD-CY group ($28,980 vs. $19,626.5 P-value < 0.0001). In conclusion, in MM plerixafor-based mobilization has superior efficacy, but significantly higher mobilization costs compared to LD-CY mobilization. Our data caution against the use of LD-CY in MM patients for mobilization, especially after induction with lenalidomide-containing regimens.

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Toward a More Rational Policy for Autologous Hematopoietic Stem Cell Mobilization

Cited by 5 publications

References 14 publications

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

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

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

Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy‐era with plerixafor and G‐CSF has superior efficacy but significantly higher costs compared to mobilization with low‐dose cyclophosphamide and G‐CSF

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