title: Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT.
abstract: The effectiveness of stem cell mobilization with G-CSF in lymphoma patients is suboptimal. We reviewed our institutional experience using chemomobilization with etoposide (VP-16; 375 mg/m(2) on days +1 and +2) and G-CSF (5 μg/kg twice daily from day +3 through the final day of collection) in 159 patients with lymphoma. This approach resulted in successful mobilization (>2 × 10(6) CD34+ cells collected) in 94% of patients (83% within 4 apheresis sessions). Fifty-seven percent of patients yielded at least 5 × 10(6) cells in 2 days and were defined as good mobilizers. The regimen was safe with a low rate of rehospitalization. Average costs were $14 923 for good mobilizers and $27 044 for poor mobilizers (P<0.05). Using our data, we performed a 'break-even' analysis that demonstrated that adding two doses of Plerixafor to predicted poor mobilizers at the time of first CD34+ cell count would achieve cost neutrality if the frequency of good mobilizers were to increase by 21%, while the frequency of good mobilizers would need to increase by 25% if three doses of Plerixafor were used. We conclude that chemomobilization with etoposide and G-CSF in patients with lymphoma is effective, with future opportunities for cost-neutral improvement using novel agents.
authors.affiliation: Bone Marrow and Stem Cell Transplantation Program, Division of Hematology and Oncology, Lineberger Comprehensive Center Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. wawood@med.unc.edu
authors.forename: W A
authors.initials: WA
authors.lastname: Wood
authors.forename: J
authors.initials: J
authors.lastname: Whitley
authors.forename: R
authors.initials: R
authors.lastname: Goyal
authors.forename: P M
authors.initials: PM
authors.lastname: Brown
authors.forename: A
authors.initials: A
authors.lastname: Sharf
authors.forename: R
authors.initials: R
authors.lastname: Irons
authors.forename: K V
authors.initials: KV
authors.lastname: Rao
authors.forename: A
authors.initials: A
authors.lastname: Essenmacher
authors.forename: J S
authors.initials: JS
authors.lastname: Serody
authors.forename: J M
authors.initials: JM
authors.lastname: Coghill
authors.forename: P M
authors.initials: PM
authors.lastname: Armistead
authors.forename: S
authors.initials: S
authors.lastname: Sarantopoulos
authors.forename: D A
authors.initials: DA
authors.lastname: Gabriel
authors.forename: T C
authors.initials: TC
authors.lastname: Shea
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000191:economics; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000191:economics; D064592:Autografts; D001596:Benzylamines; D003365:Costs and Cost Analysis; D000080027:Cyclams; D005047:Etoposide / Q000008:administration & dosage / Q000191:economics; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics* / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000191:economics; D006689:Hodgkin Disease / Q000191:economics / Q000628:therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged
chemical_list: D019380:Anti-HIV Agents; D000972:Antineoplastic Agents, Phytogenic; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; C088327:plerixafor