title: Clinical impact and resource utilization after stem cell mobilization failure in patients with multiple myeloma and lymphoma.
abstract: High-dose chemotherapy in conjunction with auto-SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal stem cell mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of stem cell mobilization attempts at our institution from 2001 to 2007 to determine the frequency of suboptimal mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1775 patients undergoing mobilization during the study period, stem cell collection (defined by the number of CD34+ cells/kg) was 'optimal' (> or = 5 x 10(6)) in 53%, 'low' (> or = 2-5 x 10(6)) in 25%, 'poor' (<2 x 10(6)) in 10%, and 'failed' (<10 CD34+ cells/microl) in 12%. In the 47% of collections that were less than optimal, increased resource consumption included increased use of growth factors and antibiotics, subsequent chemotherapy mobilization, increased transfusional support, more apheresis procedures, and more frequent hospitalization. This usually unappreciated resource utilization associated with stem cell mobilization failure highlights the need for more effective mobilization strategies.
authors.affiliation: Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA. gertz.morie@mayo.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Gertz
authors.forename: R C
authors.initials: RC
authors.lastname: Wolf
authors.forename: I N M
authors.initials: IN
authors.lastname: Micallef
authors.forename: D A
authors.initials: DA
authors.lastname: Gastineau
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000706:statistics & numerical data*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D040841:Resource Allocation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents