Retrospective comparison of filgrastim plus plerixafor to other regimens for remobilization after primary mobilization failure: clinical and economic outcomes.
We performed a retrospective analysis to evaluate clinical and economic outcomes in patients receiving remobilization therapy after primary mobilization failure. Our primary endpoint was to compare filgrastim plus plerixafor to other regimens in their ability to collect a target cell dose of at least 2 million CD34+ cells/kg (cumulative). Of 96 consecutive patients who failed their primary mobilization therapy and in whom a second mobilization was attempted, remobilization consisted of filgrastim plus plerixafor (n = 38), filgrastim with or without sargramostim (n = 43), or chemotherapy plus filgrastim (n = 15), 84% of filgrastim/plerixafor patients were able to collect at least 2 million CD34+ cells/kg from both mobilizations, compared to 60% of patients mobilized with chemotherapy/filgrastim and 79% of the filgrastim ± sargramostim patients (P = 0.17). However, when combined with cells collected from the first mobilization, 53% of filgrastim/plerixafor patients reached the target of 2 million CD34+ cells in one apheresis, compared to 20% of those receiving chemotherapy/filgrastim and 28% of those receiving filgrastim ± sargramostim (P = 0.02). Resource utilization, mobilization drug costs, clinical care costs, and total costs were significantly different. We conclude that while filgrastim/plerixafor is the most efficient remobilization strategy, those clinical benefits may not translate into lower cost, especially when multiple days of plerixafor administration are required.
Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida, USA. Janelle.perkins@moffitt.org
Janelle B
JB
Perkins
Jamie F
JF
Shapiro
Ryan N
RN
Bookout
Gary C
GC
Yee
Claudio
C
Anasetti
William E
WE
Janssen
Hugo F
HF
Fernandez
D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000097:blood; D001596:Benzylamines; D002173:Cancer Care Facilities; D000080027:Cyclams; D016527:Drug Costs; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D000069585:Filgrastim; D005431:Florida; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics* / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000191:economics
D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim; C088327:plerixafor