Adults undergoing hematopoietic stem cell transplant (HSCT) are at risk for vitamin D deficiency. After HSCT, exposure to sunlight is restricted, and patients may experience poor nutrition and malabsorption from HSCT-related side effects. Vitamin D affects bone health and immunologic processes. The aim of this project is to establish a process for monitoring and treating vitamin D deficiency and to evaluate if therapeutic vitamin D levels are attainable posttransplant using an HSCT vitamin D replacement algorithm. A multidisciplinary group led by advanced practice providers established a workflow for monitoring and supplementing vitamin D and created an HSCT vitamin D replacement guideline. The medical records of 144 adult HSCT patients were reviewed, and the records of another 72 patients were reviewed a year later. Historical baseline data before the intervention found that 81% of patients were vitamin D deficient and 30% received supplementation. Postintervention and at 1-year follow-up, 76% and 65% of patients were vitamin D deficient before transplant and 97.1% and 100%, respectively, received supplementation for vitamin D deficiency. Post-HSCT compliance with monitoring demonstrated that approximately 91% of patients had a vitamin D level checked within 6 months of transplant. After implementation of the algorithm, there was a statistically significant difference (p < .001) between deficient vitamin D levels pretransplant (72.9%) and posttransplant (26.4%). Results demonstrate sustained compliance over a 2-year period with monitoring and supplementation of vitamin D pre-and peritransplant. Aggressive vitamin D repletion posttransplant decreased the incidence of vitamin D deficiency in HSCT patients. Further study is needed to investigate the long-term effects of vitamin D repletion on posttransplant complications.

4059 Background: The combination of cyclophosphamide plus G-CSF has been the standard approach for autologous stem cell mobilization in Multiple Myeloma (MM) patients treated at MSKCC for many years. However with the recent FDA approval of plerixafor and its proven efficacy for stem cell collection in patients who had failed collection with cyclophosphamide and G-CSF, the use of plerixafor as first line agent has been advocated for patients with MM. Although proof of improved efficacy of such an approach over G-CSF/cyclophosphamide mobilization remains paramount, comparison of cost analysis between the 2 approaches is also an important parameter that needs to be considered before endorsing plerixafor as first line mobilization agent. Study Design and Method: We performed a retrospective analysis of all MM patients treated between 11/2008 and 3/2011 who received either cyclophosphamide plus G-CSF or plerixafor plus G-CSF as first line mobilization regimen. During this period of time, the target number of stem cell collection was 10 × 106stem cells/kg and patients collecting less than 4 × 106 stem cells/kg were considered mobilization failures and had a second attempt at stem cell mobilization using an alternative approach. Some patients received plerixafor as salvage regimen after failing cyclophosphamide mobilization, while others were re-challenged with a second cycle of plerixafor with cyclophosphamide and G-CSF after failing first line upfront plerixafor mobilization. Mobilization costs accounted for both groups included the costs associated with upfront mobilization, the second line mobilization in patients failing a first mobilization, as well as complications directly related to the mobilization procedures and consist of the following: Costs of drugs cyclophosphamide 3000 mg/m2, plerixafor 0.24 mg/kg, G-CSF 10 mcg/kg per dose administered prior and during pheresis sessions; hospitalization for cyclophosphamide administration; pheresis sessions; laboratory tests on pheresis days; and re-hospitalization occurring within 15 days of either mobilization approaches and considered directly related to the mobilization procedure. All costs were calculated using the institution's ratio of cost to charges, and were normalized and adjusted based on institutional charges for 2010. Results: Ninety-eight patients received cyclophosphamide and G-CSF while thirty-five patients received plerixafor as first line mobilization regimens. Eleven (11%) patients were readmitted due to cyclophosphamide complications, with an average hospital stay of 6.9 days, while none in the plerixafor arm was hospitalized. Twenty-one (21%) of the cyclophosphamide group failed mobilization and received plerixafor as salvage regimen of which 3 (3.1%) failed again and are considered ultimate failures. Two (6%) patients failed upfront mobilization with plerixafor and failed salvage mobilization and are considered ultimate failures (6%). The average number of pheresis sessions performed was 3.4 and 2.2 in the cyclophosphamide and plerixafor upfront groups respectively. In total the average cost per patient who received cyclophosphamide was 1.6 times greater than that of the patients who received plerixafor upfront. Conclusion: This cost analysis indicates that the use of plerixafor upfront for stem cell mobilization may be more cost effective than the current widely used approach employing cyclophosphamide. The cost difference between the two approaches could be attributed to several factors: Cyclophosphamide mobilization requires an initial inpatient hospitalization in our institution and often results in re-admissions due to expected toxicity; additionally, the rate of failures, and therefore need for an additional salvage mobilization appears to be much higher with cyclophosphamide; upfront plerixafor was associated with fewer pheresis sessions, and reduced G-CSF use. As many institutions administer cyclophosphamide mobilization on an outpatient basis, it is important to note that the cost benefit of plerixafor upfront remains even if the hospitalization cost of cyclophosphamide mobilization is removed; the cost ratio of cyclophosphamide becomes 1.3 times that of plerixafor. Overall, this single institution study provides, in the context of current clinical practices at MSKCC, the rational for adopting the use of plerixafor as upfront mobilization agent in MM patients. Disclosures: No relevant conflicts of interest to declare.

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