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

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.

• Authors: S Afifi, N G Adel, S Devlin, E Duck, J Vanak, H Landau, D J Chung, N Lendvai, A Lesokhin, N Korde, L Reich, O Landgren, S Giralt, H Hassoun
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 51 Issue 4 Pg. 546-52 (Apr 2016) ISSN: 1476-5365 [Electronic] England
• PMID: 26726942 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Benzylamines
• Cyclams
• Heterocyclic Compounds
• Granulocyte Colony-Stimulating Factor
• Cyclophosphamide
• plerixafor

Topics

• Autografts
• Benzylamines
• Costs and Cost Analysis
• Cyclams
• Cyclophosphamide (administration & dosage, economics)
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage, economics)
• Hematopoietic Stem Cell Mobilization (economics)
• Hematopoietic Stem Cell Transplantation (economics)
• Heterocyclic Compounds (administration & dosage, economics)
• Humans
• Male
• Multiple Myeloma (economics, therapy)