Faculty Collaboration Database

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. J Clin Apher 2013 Oct;28(5):359-67

Date

06/15/2013

Pubmed ID

23765597

DOI

10.1002/jca.21280

Scopus ID

2-s2.0-84885958621 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

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.

Author List

Chaudhary L, Awan F, Cumpston A, Leadmon S, Watkins K, Tse W, Craig M, Hamadani M

Authors

Lubna N. Chaudhary MD Associate Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Anti-Bacterial Agents
Antigens, CD34
Antineoplastic Agents
Benzylamines
Boronic Acids
Bortezomib
Cohort Studies
Cyclophosphamide
Female
Granulocyte Colony-Stimulating Factor
Health Care Costs
Hematopoietic Stem Cell Mobilization
Heterocyclic Compounds
Humans
Leukocytes, Mononuclear
Male
Middle Aged
Multiple Myeloma
Peripheral Blood Stem Cell Transplantation
Pyrazines
Thalidomide
Time Factors
Transplantation Conditioning
Treatment Outcome