title: Effectiveness and cost analysis of "just-in-time" salvage plerixafor administration in autologous transplant patients with poor stem cell mobilization kinetics.
abstract: BACKGROUND
  Plerixafor is a recently Food and Drug Administration (FDA)-approved CXCR4 antagonist, which is combined with granulocyte-colony-stimulating factor (G-CSF) to facilitate stem cell mobilization of lymphoma and myeloma patients.
  
  
  METHODS
  To evaluate the effectiveness and the related costs of a "just-in-time" strategy of plerixafor administration, we performed a retrospective cohort study comparing 148 consecutive lymphoma and myeloma patients in whom mobilization was attempted during 2008 before the Food and Drug Administration (FDA) approval of plerixafor with 188 consecutive patients mobilized during 2009 after FDA approval.
  
  
  RESULTS
  Plerixafor was administered to 64 of 188 patients considered to be at risk for mobilization failure due to either their medical history ("high risk," n = 23) or the occurrence of peripheral blood CD34+ count of fewer than 15 × 10(6) cells/L with a white blood cell count of greater than 10 × 10(9) cells/L after at least 5 days of G-CSF administration (just-in-time, n = 41). The success rates of collecting a minimum transplant CD34+ cell dose (≥2 × 10(6) cells/kg) or target cell dose (≥5 × 10(6) lymphoma or ≥10 × 10(6) CD34+ cells/kg myeloma) in the just-in-time patients compared favorably with the 36 poor mobilizers collected with G-CSF alone: 93% versus 72% and 42% versus 22%, respectively.
  
  
  CONCLUSIONS
  The use of plerixafor in selected high-risk patients and poor mobilizers did not increase the total charges associated with stem cell collection when compared with poor mobilizers treated with G-CSF alone. The targeted use of plerixafor increased the overall success rate of mobilizing a minimum number of CD34+ cells from 93% to 98% in patients with hematologic malignancies scheduled for autotransplant and increased the overall charges associated with stem cell collection in all patients by an average of 17%.
authors.affiliation: Winship Cancer Institute, Department of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Ellie
authors.initials: E
authors.lastname: Hamilton
authors.forename: Louette
authors.initials: L
authors.lastname: Vaughn
authors.forename: Michael
authors.initials: M
authors.lastname: Graiser
authors.forename: Heather
authors.initials: H
authors.lastname: Renfroe
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Lechowicz
authors.forename: Amelia
authors.initials: A
authors.lastname: Langston
authors.forename: Jefferson Mark
authors.initials: JM
authors.lastname: Prichard
authors.forename: Darlene
authors.initials: D
authors.lastname: Anderson
authors.forename: Charise
authors.initials: C
authors.lastname: Gleason
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Kaufman
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000097:blood; D001596:Benzylamines; D001781:Blood Component Removal; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D000080027:Cyclams; D004334:Drug Administration Schedule; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000187:drug effects; D006571:Heterocyclic Compounds / Q000008:administration & dosage* / Q000494:pharmacology; 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 / Q000191:economics / Q000379:methods*; D019718:Receptors, CXCR4 / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D016879:Salvage Therapy; D013997:Time Factors; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D019718:Receptors, CXCR4; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor