Cost and Clinical Analysis of Autologous Hematopoietic Stem Cell Mobilization with G-CSF and Plerixafor Compared to G-CSF and Cyclophosphamide

Abstract

Plerixafor plus granulocyte-colony stimulating factor (G-CSF) has been shown to mobilize more CD34(+) cells than G-CSF alone for autologous hematopoietic stem cell transplantation (HSCT). However, many centers use chemotherapy followed by G-CSF to mobilize CD34(+) cells prior to HSCT. We performed a retrospective study of patients who participated in the expanded access program (EAP) of plerixafor and G-CSF for initial mobilization of CD34(+) cells, and compared outcomes to matched historic controls mobilized with cyclophosphamide 3-5 g/m(2) and G-CSF at 2 centers that participated in the EAP Control patients were matched for age, sex, disease, disease stage, and number of prior therapies. Mobilization costs were defined to be the costs of medical procedures, resource utilization, and medications. Median national CMS reimbursement rates were used to establish the costs of procedures, hospitalization, provider visits, apheresis, CD34(+) cell processing and cryopreservation. Average sale price was used for G-CSF, plerixafor, cyclophosphamide, MESNA, antiemetics, and antimicrobials. A total of 33 patients from the EAP and 33 matched controls were studied. Two patients in the control group were hospitalized for neutropenic fever during the mobilization period. Apheresis started on the scheduled day in 33 (100%) study patients and in 29 (88%) control patients (P = 0.04). Sixteen (48%) control patients required weekend apheresis. There was no difference in number of CD34(+) cells collected between the groups, and all patients proceeded to HSCT with no difference in engraftment outcomes. Median total cost of mobilization was not different between the plerixafor/G-CSF and control groups ($14,224 versus $18,824; P = .45). In conclusion, plerixafor/G-CSF and cyclophosphamide/G-CSF for upfront mobilization of CD34(-) cells resulted in similar numbers of cells collected, costs of mobilization, and clinical outcomes. Additionally, plerixafor/G-CSF mobilization resulted in more predictable days of collection, no weekend apheresis procedures, and no unscheduled hospital admissions.

Plerixafor and G-CSF for autologous stem cell mobilization in patients with NHL, Hodgkin’s lymphoma and multiple myeloma: results from the expanded access program

“…A previous retrospective study, comparing plerixafor plus G-CSF (P þ G) with cyclophosphamide plus G-CSF (CM þ G), found that the cost of HSC mobilization and collection increased dramatically when multiple days of G-CSF/plerixafor and apheresis were required. 11 Although the total median mobilization costs were similar in the two groups, P þ G patients had more predictable apheresis schedules, used less resources and had fewer hospitalizations.…”

Clinical experience with a simple algorithm for plerixafor utilization in autologous stem cell mobilization

“…G-CSF þ plerixafor has been calculated to be similar in cost to chemo-mobilization. 13 However, chemo-mobilization exposes the patient to the risks of neutropenic fever, hospital re-admission and unpredictable collections. It also can result in weekend collections that increases costs related to staffing.…”

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

“…Nevertheless, chemotherapy mobilization is associated with significant morbidities, including increased risk of infection and rate of hospitalization and excessive cost. [15][16][17]24,35 Retrospective studies have been performed evaluating the role of CY plus filgrastim mobilization after lenalidomide-containing treatment regimens. Collectively, the data reveal that mobilization with CY and filgrastim results in an increased number of CD34 þ cells collected and reduced rate of mobilization failure when compared with mobilization with filgrastim alone.…”

“…[7][8][9][10] This negative effect, noticed particularly with growth factor mobilization, is at least partially overcome with the use of chemotherapy mobilization, [11][12][13] although this strategy carries higher cost and toxicity. [14][15][16][17] The CXCR4-SDF1-binding inhibitor plerixafor dramatically enhances filgrastim-based CD34 þ mobilization in patients with MM, 18 but is expensive, limiting its use in all patients undergoing mobilization. Preliminary experience suggests that the majority of lenalidomide-exposed patients failing filgrastim mobilization will adequately mobilize CD34 þ cells with filgrastim plus plerixafor.…”