title: Efficacy and cost-benefit analysis of risk-adaptive use of plerixafor for autologous hematopoietic progenitor cell mobilization.
abstract: BACKGROUND
  Plerixafor (P) reduces mobilization failure rates but it is very expensive. For better utilization of P, we employed a risk-adaptive strategy of using it only in patients who are at high risk of mobilization failure, defined by peripheral blood (PB) CD34+ cell count of fewer than 10×10(6)/L after 4 days of filgrastim (F) alone.
  
  
  METHODS
  Herein, we present the results of efficacy and cost-benefit analysis of this risk-adaptive approach for hematopoietic progenitor cell (HPC) collection. All patients received daily F for 4 days, and P was added for those "at-risk" patients from Day 4 with apheresis commencing the following morning. F and P were continued daily for up to a maximum of 4 days or until more than 5×10(6) CD34+ cells/kg were collected. Forty-two transplant-eligible patients underwent HPC mobilization.
  
  
  RESULTS
  Eighteen patients mobilized with F alone and 24 patients required P with F. Two patients failed adequate HPC mobilization after F+P. Addition of P increased the PB CD34+ count by 6.8-fold with a mean yield of 4.9×10(6) CD34+ cells/kg. Decision-analysis model estimated cost-effectiveness for this risk-adaptive approach of using P with savings of $19,300/patient. Engraftment after HPC infusion was similar among the patients regardless of mobilization regimens.
  
  
  CONCLUSIONS
  These results suggest that addition of P to F based on a risk-adaptive strategy significantly reduces the frequency of mobilization failures and is also cost-effective.
authors.affiliation: Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida 32224, USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Vishnu
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.forename: Athena
authors.initials: A
authors.lastname: Paulsen
authors.forename: Abba C
authors.initials: AC
authors.lastname: Zubair
mesh_terms: D000328:Adult; D000368:Aged; D001596:Benzylamines; D003362:Cost-Benefit Analysis; D000080027:Cyclams; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation; D006571:Heterocyclic Compounds / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim; C088327:plerixafor