title: GCSF with or without chemotherapy compared to Plerixafor with GCSF as salvage mobilization regimen in patients with multiple myeloma and lymphoma: collection effectiveness and cost effectiveness analysis.
abstract: BACKGROUND
  Plerixafor is a novel mobilizing agent of peripheral blood stem cells (PBSCs) in lymphoma and multiple myeloma (MM) patients whose cells mobilize poorly. Due to the substantial cost associated with its use, we aimed to compare the effectiveness and cost effectiveness of Plerixafor + GCSF (PG) versus GCSF ± Chemotherapy (GC) as salvage mobilization regimens.
  
  
  METHODS
  The charts of consecutive lymphoma and MM patients who had undergone at least one previous attempt of PBSCs mobilization that failed or resulted in an insufficient cell dose for transplant between 2007 and 2010 were retrospectively reviewed. Patients identified received salvage mobilization with GC (prior to 2009) or PG after Plerixafor's FDA approval. Data collected included demographics, medical histories, apheresis yields and transplant outcome. The cost effectiveness analysis was from the perspective of the Jordanian Ministry of Health. The incremental cost effectiveness ratio (ICER) was calculated by dividing the difference in cost by the difference in effectiveness for the two regimens.
  
  
  RESULTS
  Five patients received GC and twelve received PG. A minimum CD34+ cell dose of 2 × 10(6) cells/kg was collected from 8 patients (67%) in the PG group compared to 3 (60%) in the GC group (p=0.79). The average costs were US$8570 and US$25,700 for the GC group and the PG group, respectively. The ICER was US$244,714 per successful stem cell collection.
  
  
  CONCLUSIONS
  Salvage Plerixafor use showed a non-significant improvement in PBSCs collection with a significant increase in cost. Prospective comparative effectiveness studies are warranted to inform the optimal salvage mobilization regimen. To our knowledge, this is the first study from the Middle East to describe the effectiveness and cost effectiveness of Plerixafor.
authors.affiliation: Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan.
authors.forename: Fawzi
authors.initials: F
authors.lastname: Abdel-Rahman
authors.forename: Haitham W
authors.initials: HW
authors.lastname: Tuffaha
authors.forename: Shanta
authors.initials: S
authors.lastname: Sharma
authors.forename: Husam Abu
authors.initials: HA
authors.lastname: Jazar
authors.forename: Nilly
authors.initials: N
authors.lastname: Hussein
authors.forename: Adnan
authors.initials: A
authors.lastname: Saad
authors.forename: Omar
authors.initials: O
authors.lastname: Al Rawi
authors.forename: Ayad
authors.initials: A
authors.lastname: Hussein
mesh_terms: D000328:Adult; D001596:Benzylamines; D003362:Cost-Benefit Analysis; D000080027:Cyclams; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics* / Q000627:therapeutic use*; D006571:Heterocyclic Compounds / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000191:economics; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor
keywords: Plerixafor; cost effectiveness; mobilization; transplant