A Cost Effective Analysis of a Risk-Adapted Algorithm for Plerixafor Use in Autologous Peripheral Blood Stem Cell Mobilization

Micallef, I.N.; Sinha, Shirshendu; Gastineau, Dennis A.; Wolf, Robert C.; Inwards, David J.; Gertz, Morie A.; Hayman, Suzanne R.; Hogan, W.J.; Johnston, Patrick B.; Lacy, M.Q.; Ansell, Steven M.; Buadi, Francis K.; Dingli, David; Dispenzieri, Angela; Litzow, Mark R.; Porrata, L.F.; Winters, Jeffrey L.; Kumar, Santosh

doi:10.1016/j.bbmt.2010.12.030

Cited by 6 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consequently, several groups have developed algorithms for preemptive ('just in time') use of plerixafor based mostly on PB-CD34 þ count. 22,38,39 Our algorithm has a very high success rate while still avoiding the use of plerixafor in nearly half the patients. 14,22 There are limited data on the use of filgrastim plus plerixafor mobilization in patients treated with lenalidomide.…”

Section: Discussionmentioning

confidence: 95%

“…We suspect the disparity in mobilization outcomes between our preemptive series and the one reported by the Mayo group may be attributed to the differences in threshold for use of plerixafor. 38 The choice of a lower threshold by that group may have precluded the use of plerixafor in patients with borderline (but yet above the threshold) CD34 þ count on the 4th day of mobilization leading to multiple suboptimal collections.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Growth factor plus preemptive (‘just-in-time’) plerixafor successfully mobilizes hematopoietic stem cells in multiple myeloma patients despite prior lenalidomide exposure

Costa

Abbas

Hogan

et al. 2012

Bone Marrow Transplant

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Growth factor plus preemptive (‘just-in-time’) plerixafor successfully mobilizes hematopoietic stem cells in multiple myeloma patients despite prior lenalidomide exposure

Costa

Abbas

Hogan

et al. 2012

Bone Marrow Transplant

View full text Add to dashboard Cite

“…Patients who had a day-1 yield of <1.5 also predictably required plerixafor due to subsequent poor daily yields. Therefore, in design of plerixafor-2, the day-5 PB CD34 count was eliminated, the day-1 yield of <1.5 Â 10 6 CD34/kg and a higher PB CD34 target for patients collecting for more than 1 transplantation were added [23]. The hypothesis for the design of plerixafor-2 was by administering plerixafor earlier to the patients who required it because of poor yields, may lessen the number of days of apheresis, days of plerixafor use, and improve the total apheresis yield.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of a Risk-Adapted Algorithm of Plerixafor Use for Autologous Peripheral Blood Stem Cell Mobilization

Micallef

Sinha

Gastineau

et al. 2013

Biology of Blood and Marrow Transplantation

View full text Add to dashboard Cite

Historically, up to 30% of patients were unable to collect adequate numbers of peripheral blood stem cells (PBSCs) for autologous stem cell transplantation (ASCT). Plerixafor in combination with granulocyte colony-stimulating factor (G-CSF) has shown superior results in mobilizing peripheral blood (PB) CD34+ cells in comparison to G-CSF alone, but its high cost limits general use. We developed and evaluated risk-adapted algorithms for optimal utilization of plerixafor. In plerixafor-1, PBSC mobilization was commenced with G-CSF alone, and if PB CD34 on day 4 or day 5 was <10/μL, plerixafor was administered in the evening, and apheresis commenced the next day. In addition, if on any day, the daily yield was <0.5 × 10(6) CD34/kg, plerixafor was added. Subsequently, the algorithm was revised (plerixafor-2) with lower thresholds. If day-4 PB CD34 <10/μL for single or <20/μL for multiple transplantations, or day-1 yield was <1.5 × 10(6) CD34/kg, or any subsequent daily yield was <0.5 × 10(6) CD34/kg, plerixafor was added. Three time periods were analyzed for results and associated costs: January to December 2008 (baseline cohort; 319 mobilization attempts in 278 patients); February to November 2009 (plerixafor-1; 221 mobilization attempts in 216 patients); and December 2009 to June 2010 (plerixafor-2; 100 mobilization attempts in 98 patients). Plerixafor-2 shows a significant improvement in PB CD34 collection, increased number of patients reaching minimum and optimal goals, fewer days of apheresis, and fewer days of mobilization/collection, albeit at increased costs. In conclusion, although the earlier identification of ineffective PBSC mobilization and initiation of plerixafor (plerixafor-2) increases the per-patient costs of PBSC mobilization, failure rates, days of apheresis, and total days of mobilization/collection are lower.

show abstract

“…Although many MM patients with well-controlled disease may be able to successfully mobilize stem cells with cytokine-only strategies, 8 mobilization failure rates in myeloma patients with certain risk factors (prior lenalidomide use, radiotherapy, heavily pretreated disease, advanced age and so on) approach 30-35%. [17][18][19] Chemotherapy-based methods may be preferred when immediate control of the underlying disease is required. 15 However, the toxicity and resource utilization with chemotherapybased mobilization strategies are well known.…”

Section: Discussionmentioning

confidence: 99%

Comparable efficacy and lower cost of PBSC mobilization with intermediate-dose cyclophosphamide and G-CSF compared with plerixafor and G-CSF in patients with multiple myeloma treated with novel therapies

Awan

Kochuparambil

Falconer

et al. 2013

Bone Marrow Transplant

View full text Add to dashboard Cite

Studies comparing the efficacy and cost of stem cell mobilization with intermediate-dose CY (ID-CY) and G-CSF against plerixafor and G-CSF, specifically in multiple myeloma (MM) patients treated in the novel therapy era, are not available. Eighty-eight consecutive patients undergoing mobilization with ID-CY (3-4 g/m 2 ) and G-CSF (n ¼ 55) were compared with patients receiving plerixafor and G-CSF (n ¼ 33). Compared with plerixafor, ID-CY use was associated with higher median peak peripheral blood CD34 þ cell count (68 vs 160 cells/mL, Po0.001), and CD34 þ cell yield on day 1 of collection (6.9 Â 10 6 vs 11.7 Â 10 6 cells/kg, Po0.001). Total CD34 þ cell yield was significantly higher in the ID-CY patients (median collection 16.6 Â 10 6 vs 11.6 Â 10 6 cells/kg; Po0.001). ID-CY use was associated with significantly more frequent episodes of febrile neutropenia (16.3% vs 0%; P ¼ 0.02), intravenous antibiotic use (16.3% vs 3%; P ¼ 0.03) and hospitalizations (P ¼ 0.02). The average total cost of mobilization in the plerixafor group was significantly higher compared with the ID-CY group ($28 980 vs $22 504.8; P ¼ 0.001). Our data indicate robust stem cell mobilization in MM patients treated with novel agents, with G-CSF and either ID-CY or plerixafor. When compared with plerixafor, ID-CY-containing mobilization was associated with significantly lower average total mobilization costs.

show abstract

A Cost Effective Analysis of a Risk-Adapted Algorithm for Plerixafor Use in Autologous Peripheral Blood Stem Cell Mobilization

Cited by 6 publications

References 0 publications

Growth factor plus preemptive (‘just-in-time’) plerixafor successfully mobilizes hematopoietic stem cells in multiple myeloma patients despite prior lenalidomide exposure

Growth factor plus preemptive (‘just-in-time’) plerixafor successfully mobilizes hematopoietic stem cells in multiple myeloma patients despite prior lenalidomide exposure

Cost-Effectiveness Analysis of a Risk-Adapted Algorithm of Plerixafor Use for Autologous Peripheral Blood Stem Cell Mobilization

Comparable efficacy and lower cost of PBSC mobilization with intermediate-dose cyclophosphamide and G-CSF compared with plerixafor and G-CSF in patients with multiple myeloma treated with novel therapies

Contact Info

Product

Resources

About