title: Outcomes and costs of autologous stem cell mobilization with chemotherapy plus G-CSF vs G-CSF alone.
abstract: Chemotherapy plus G-CSF (C+G) and G-CSF alone are two of the most common methods used to mobilize CD34(+) cells for autologous hematopoietic SCT (AHSCT). In order to compare and determine the real-world outcomes and costs of these strategies, we performed a retrospective study of 226 consecutive patients at 11 medical centers (64 lymphoma, 162 multiple myeloma), of whom 55% of lymphoma patients and 66% of myeloma patients received C+G. Patients with C+G yielded more CD34(+) cells/day than those with G-CSF alone (lymphoma: average 5.51 × 10(6) cells/kg on day 1 vs 2.92 × 10(6) cells/kg, P=0.0231; myeloma: 4.16 × 10(6) vs 3.69 × 10(6) cells/kg, P<0.00001) and required fewer days of apheresis (lymphoma: average 2.11 vs 2.96 days, P=0.012; myeloma: 2.02 vs 2.83 days, P=0.0015), although nearly all patients ultimately reached the goal of 2 × 10(6) cells/kg. With the exception of higher rates of febrile neutropenia in myeloma patients with C+G (17% vs 2%, P<0.05), toxicities and other outcomes were similar. Mobilization with C+G cost significantly more (lymphoma: median $10,300 vs $7300, P<0.0001; myeloma: $8800 vs $5600, P<0.0001), although re-mobilization adds $6700 for drugs alone. Our results suggest that although both C+G and G-CSF alone are effective mobilization strategies, C+G may be more cost-effective for patients at high risk of insufficient mobilization.
authors.affiliation: Divison of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Sung
authors.forename: D T
authors.initials: DT
authors.lastname: Grima
authors.forename: L M
authors.initials: LM
authors.lastname: Bernard
authors.forename: S
authors.initials: S
authors.lastname: Brown
authors.forename: G
authors.initials: G
authors.lastname: Carrum
authors.forename: L
authors.initials: L
authors.lastname: Holmberg
authors.forename: M E
authors.initials: ME
authors.lastname: Horwitz
authors.forename: J L
authors.initials: JL
authors.lastname: Liesveld
authors.forename: J
authors.initials: J
authors.lastname: Kanda
authors.forename: B
authors.initials: B
authors.lastname: McClune
authors.forename: P
authors.initials: P
authors.lastname: Shaughnessy
authors.forename: G J
authors.initials: GJ
authors.lastname: Tricot
authors.forename: N J
authors.initials: NJ
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics* / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D014182:Transplantation, Autologous / Q000191:economics / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D005047:Etoposide; D003520:Cyclophosphamide