Development and validation of a decision-making algorithm to guide the use of plerixafor for autologous hematopoietic stem cell mobilization.
Plerixafor is an inhibitor of CXCR-4 (CXC chemokine receptor-4)/SDF (stromal cell-derived factor)-1 binding used in combination with granulocyte colony-stimulating factor (G-CSF) for mobilization of autologous peripheral blood hematopoietic stem cells (HSCs). We developed a data-generated, cost-saving decision-making algorithm that uses the CD34+ count in the peripheral blood on the fourth day of G-CSF administration (PB-CD34+), and the collection target (T-CD34+) to decide between continuing G-CSF only (G approach) or adding plerixafor to the mobilization regimen (G+P approach) aiming at the lowest cost. The G+P approach was more cost-effective with lower PB-CD34+. It was possible to determine, for each T-CD34+, the maximum PB-CD34+ for which the G+P approach is cost-effective, generating an algorithm for the use of plerixafor. We validated this algorithm in a cohort of 34 patients undergoing HSC mobilization. In all, 11 patients completed collection on the G approach and 23 patients on the G+P approach, with 91% of the patients completing collection within the predicted number of apheresis sessions. All patients who underwent transplantation engrafted with minimal differences in engraftment time between G and G+P approaches. This validated algorithm provides a potential cost-saving decision tool for the use of plerixafor in autologous HSC mobilization.
Costa
L J
LJ
Division of Haematology/Oncology, Medical University of South Carolina, Charleston, SC, USA. costalj@musc.edu
Alexander
E T
ET
Hogan
K R
KR
Schaub
C
C
Fouts
T V
TV
Stuart
R K
RK
D000465:Algorithms; D018952:Antigens, CD34 / Q000097:blood; D001596:Benzylamines; D001772:Blood Cell Count; D001781:Blood Component Removal / Q000706:statistics & numerical data; D015331:Cohort Studies; D017046:Cost Savings / Q000379:methods*; D000080027:Cyclams; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D006571:Heterocyclic Compounds / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008223:Lymphoma / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation; D014182:Transplantation, Autologous
D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor