Outcome, toxicity profile and cost analysis of autologous stem cell mobilization.
Autologous stem cell mobilization (ASCM) is conventionally done using high-dose CY plus granulocyte colony-stimulating factor (G). It is important to examine the outcomes, toxicity profile and costs of ASCM associated with CY+G. A retrospective study was conducted in 236 patients with myeloma or lymphoma undergoing ASCM with CY+G. An ideal outcome was defined as 2 × 10(6) CD34+ cells/kg collected on the planned day of collection in 1 or 2 apheresis without a negative clinical event. The total cost of ASCM including clinical events, were reported based on Medicare part-B physician, laboratory and ancillary fee schedule. ASCM was successful in 213 (90%) patients, but an ideal outcome was seen in only 50 (20%) patients. Median (interquartile range, IQR) total cost of CY+G stem cells mobilization was $10,605 ($9,230-$14,540). Ideal outcomes were associated with lower costs compared with non-ideal outcomes (median (IQR), $9914 ($8,743-$11,168) versus $11232 ($9,292-$15,518) respectively, P<0.001). The median (IQR) cost of non-ideal outcome was higher among lymphoma patients ($12,293 ($9578-$16,268)) compared with myeloma patients ($10,388 ($9,355-$14,360) (P=0.04). Although mobilization success is eventually realized with CY+G, it has a low rate of ideal outcome, associated with significant adverse events and costs.
Division of Hematology-Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-5505, USA. madan.jagasia@vanderbilt.edu
M H
MH
Jagasia
B N
BN
Savani
A
A
Neff
S
S
Dixon
H
H
Chen
A S
AS
Pickard
D000368:Aged; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D006801:Humans; D008223:Lymphoma / Q000191:economics / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000191:economics / Q000601:surgery; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide