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Comparative Study
. 2016 Apr;51(4):546-52.
doi: 10.1038/bmt.2015.322. Epub 2016 Jan 4.

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

S Afifi  1   2 , N G Adel  1   2 , S Devlin  2   3 , E Duck  2   4 , J Vanak  2   4 , H Landau  2   5   6 , D J Chung  2   5   6 , N Lendvai  2   5   6 , A Lesokhin  2   5   6 , N Korde  2   5   6 , L Reich  2   5   6 , O Landgren  2   5   6 , S Giralt  2   5   6 , H Hassoun  2   5   6
Affiliations
Comparative Study

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

S Afifi et al. Bone Marrow Transplant. 2016 Apr.

Abstract

Cyclophosphamide plus G-CSF (C+G-CSF) is one of the most widely used stem cell (SC) mobilization regimens for patients with multiple myeloma (MM). Plerixafor plus G-CSF (P+G-CSF) has demonstrated superior SC mobilization efficacy when compared with G-CSF alone and has been shown to rescue patients who fail mobilization with G-CSF or C+G-CSF. Despite the proven efficacy of P+G-CSF in upfront SC mobilization, its use has been limited, mostly due to concerns of high price of the drug. However, a comprehensive comparison of the efficacy and cost effectiveness of SC mobilization using C+G-CSF versus P+G-CSF is not available. In this study, we compared 111 patients receiving C+G-CSF to 112 patients receiving P+G-CSF. The use of P+G-CSF was associated with a higher success rate of SC collection defined as ⩾5 × 10(6) CD34+ cells/kg (94 versus 83%, P=0.013) and less toxicities. Thirteen patients in the C+G-CSF arm were hospitalized owing to complications while none in the P+G-CSF group. C+G-CSF was associated with higher financial burden as assessed using institutional-specific costs and charges (P<0.001) as well as using Medicare reimbursement rates (P=0.27). Higher rate of hospitalization, increased need for salvage mobilization, and increased G-CSF use account for these differences.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Stem cell mobilization schemas: (a). Plerixafor-based stem cell mobilization: G-CSF is administered on days 1–4; plerixafor is initiated on the evening of day 4, ~ 11 h before the first apheresis on day 5; plerixafor, G-CSF and apheresis are repeated on subsequent days until the target number of stem cells is reached, up to a maximum of four apheresis sessions. (b). Cyclophosphamide (CY)-based stem cell mobilization: CY is administered on day 1 followed by G-CSF initiated on day 2 until day 11; apheresis is started on day 12; G-CSF and apheresis are repeated on subsequent days until the target number of stem cells is reached, up to a maximum of four apheresis sessions.
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References

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