Cost analysis of a randomized stem cell mobilization study in multiple myeloma

Abstract

Upfront autologous stem cell transplantation (ASCT) is the standard therapy for younger multiple myeloma (MM) patients. MM patients usually undergo stem cell mobilization with cyclophosphamide (CY) followed by granulocyte colony-stimulating factor (G-CSF), or with G-CSF alone. A limited number of randomized studies are available comparing costs of different mobilization strategies. Eighty transplant-eligible patients aged up to 70 years with untreated MM were included in this prospective study. The patients were treated with RVD induction for three 21-day cycles and randomized 1:1 at inclusion into one of the two mobilization arms CY 2 g/m(2) + G-CSF [arm A] vs. G-CSF alone [arm B]. Plerixafor was given according to a specific algorithm if needed. Sixty-nine patients who received mobilization followed by blood graft collection were included in the cost analysis. The median total costs of the mobilization phase were significantly higher in arm A than in arm B (3855 € vs. 772 €, p ≤ 0.001). The cumulative median cost of the mobilization and collection phases was significantly lower in arm B than in arm A (8524 € vs. 11,622 €, p = 0.012). There was no significant difference between the arms in the total median costs of ASCT (n = 59) (34,997 € in arm A vs. 31,981 € in arm B, p = 0.118). Mobilization with G-CSF alone seems to be a preferable mobilization method for MM patients in terms of mobilization and apheresis costs. In addition, it requires less hospital resource utilization.

Comparison of filgrastim, pegfilgrastim, and lipegfilgrastim added to chemotherapy for mobilization of CD34+ cells in non‐Hodgkin lymphoma patients

“…The proportion of poor mobilizers (defined as B‐CD34 + peak <20 × 10 6 /L) was comparable between the three groups (Table ). The relative median cost of G‐CSF mobilization and apheresis according to the G‐CSF group is presented in Table . The total cost including plerixafor appeared to be lower in the LIPEG group (p < 0.001).…”

RVD induction and autologous stem cell transplantation followed by lenalidomide maintenance in newly diagnosed multiple myeloma: a phase 2 study of the Finnish Myeloma Group

“…Secondary endpoints were feasibility of this three-drug induction combination, overall response rate (ORR), number of CD34+ cells collected after low-dose CY + G-CSF vs. G-CSF alone mobilization, number of aphereses, and costs according to the mobilization arm, graft composition, duration of treatment, and OS. The results of the mobilization endpoints [18], graft cellular composition [21], and cost analysis of the mobilization substudy [22] have been reported previously.…”

Impact of lenalidomide‐based induction therapy on the mobilization of CD34+ cells, blood graft cellular composition, and post‐transplant recovery in myeloma patients: a prospective multicenter study

“…More recently, three drug regimens, including carfilzomib, LEN, and dexamethasone or a completely oral combination of ixazomib, LEN, and dexamethasone, have been evaluated as initial therapy in MM. The best induction therapy in the front‐line setting is currently unknown, as is the ideal method for CD34 + cell mobilization to maximize cell yields with reasonable efforts and costs …”