The use of plerixafor in selected high-risk patients and poor mobilizers did not increase the total charges associated with stem cell collection when compared with poor mobilizers treated with G-CSF alone. The targeted use of plerixafor increased the overall success rate of mobilizing a minimum number of CD34+ cells from 93% to 98% in patients with hematologic malignancies scheduled for autotransplant and increased the overall charges associated with stem cell collection in all patients by an average of 17%.

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High‐dose therapy (HDT) and autologous stem cell transplantation (ASCT) are established components in the treatment of multiple myeloma; however, undergoing transplantation usually requires hematopoietic support, which poses a challenge among patients who are unwilling to receive blood products. Most transplant centers decline HDT/ASCT to these patients because of safety concerns. Here, the authors’ institutional data on safety, engraftment parameters, and survival outcomes after bloodless ASCT (BL‐ASCT) are examined among patients with myeloma. This retrospective case‐control study included patients who underwent BL‐ASCT and Transfusion‐supported ASCT (TS‐ASCT) at Emory University Hospital between August 2006 and August 2016. In total, 24 patients who underwent BL‐ASCT and 70 who underwent TS‐ASCT were included. The median time for neutrophil engraftment, platelet engraftment and the median length of hospital stay all were equivalent for both groups. There were no transplant‐related cardiovascular complications or mortality in either the BL‐ASCT group or the TS‐ASCT group. The median progression‐free survival was 36 months and 44 months in the BL‐ASCT and TS‐ASCT groups, respectively (P = .277), and the median OS was not reached in either group at a median follow‐up of 59 months after ASCT (P = .627). There was no transplant‐related mortality at the 100‐day or 1‐year mark in either group. BL‐ASCT is safe and feasible; transplant‐related mortality, cardiovascular and hematologic complications are similar to those associated with TS‐ASCT. Furthermore, BL‐ASCT can yield similar engraftment and survival parameters comparable to those observed with TS‐ASCT.

Prior trials have shown benefits ofpalifermin in reducing the incidence and severity of oral mucositis in patients with hematological malignancies undergoing autologous hematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI)-based conditioning regimens. Similar outcomes data are lacking for patients receiving non-TBI-based regimens. We performed a retrospective evaluation on the pharmacoeconomic benefit of palifermin in the setting of non-TBI-based conditioning and autologous HSCT. 524 patients that underwent autologous HSCT for myeloma (melphalan 200 mg/m2) and lymphoma (high-dose busulfan, cyclophosphamide, and etoposide)as preparative regimen between January 2002 and December 2010 were analyzed. Usage of patient controlled analgesia (PCA) was significantly lower in the palifermin-treated groups (myeloma: 13% vs. 53%; p<0.001; lymphoma: 46% vs. 68%; p<0.001).Median total transplant charges were significantly higher in the palifermin-treated group, after controlling for inflation (myeloma: $167,820 vs. $143,200, p<0.001; lymphoma: $168,570 vs. $148,590, p<0.001). Palifermin treatment was not associated with a difference in days to neutrophil engraftment, length of stay and overall survival; and was associated with an additional cost of $5.5K (myeloma) and $14K (lymphoma) per day of PCA avoided. Future studies are suggested to evaluate the cost-effectiveness of palifermin compared with other symptomatic treatments to reduce transplant toxicity using validated measures for pain and quality of life.

More than 90% of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients receive red blood cell (RBC) or platelet transfusions in the peritransplantation period. We tested the hypothesis that transfusions are associated with the development of severe (grade III-IV) acute graft-versus-host disease (aGVHD) or mortality after allo-HSCT in a retrospective study of 322 consecutive patients receiving an allogeneic bone marrow or granulocyte colony-stimulating factor-mobilized blood stem cell graft for a hematologic malignancy. Counting transfused RBC and platelet units between day -7 pretransplantation and day +27 post-transplantation, but excluding transfusions administered after a diagnosis of aGVHD, yielded medians of 5 RBC units and 2 platelet units transfused. Sixty-three patients (20%) developed a maximal grade III-IV aGVHD with onset up to day +150 post-transplantation (median aGVHD onset of 28 days). HLA mismatch (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2 to 4.7; P = .01), and transfusion of more than the median number of RBC units (HR, 2.1; 95% CI, 1.1 to 3.7; P = .02) were independently associated with greater risk of grade III-IV aGVHD in a multivariable analysis model. Disease risk strata (HR, 1.7; 95% CI, 1.2 to 2.4 for high risk versus low risk; P = .005) and transfusion of more than the median number of RBC units (HR, 1.4; 95% CI, 1.0 to 2.0; P = .054) were independently associated with inferior overall survival. These data support our hypothesis that peritransplantation RBC transfusions are associated with the risk of developing severe aGVHD and worse overall survival following allo-HSCT, and suggest that strategies to reduce routine RBC transfusion may favorably reduce the incidence and severity of GVHD.