title: Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy-era with plerixafor and G-CSF has superior efficacy but significantly higher costs compared to mobilization with low-dose cyclophosphamide and G-CSF.
abstract: Studies comparing the efficacy and cost of peripheral blood stem and progenitor cells mobilization with low-dose cyclophosphamide (LD-CY) and granulocyte-colony stimulating factor (G-CSF) against plerixafor and G-CSF, in multiple myeloma (MM) patients treated in the novel therapy-era are not available. Herein, we report mobilization outcomes of 107 patients who underwent transplantation within 1-year of starting induction chemotherapy with novel agents. Patients undergoing mobilization with LD-CY (1.5 gm/m(2)) and G-CSF (n = 74) were compared against patients receiving plerixafor and G-CSF (n = 33). Compared to plerixafor, LD-CY was associated with a significantly lower median peak peripheral blood CD34+ cell count (68/µL vs. 36/µL, P = 0.048), and lower CD34+ cell yield on day 1 of collection (6.9 × 10(6)/kg vs. 2.4 × 10(6)/kg, P = 0.001). Six patients (8.1%) in the LD-CY group experienced mobilization failure, compared to none in the plerixafor group. The total CD34+ cell yield was significantly higher in the plerixafor group (median 11.6 × 10(6)/kg vs. 7 × 10(6)/kg; P-value = 0.001). Mobilization with LD-CY was associated with increased (albeit statistically non-significant) episodes of febrile neutropenia (5.4% vs. 0%; P = 0.24), higher use of intravenous antibiotics (6.7% vs. 3%; P = 0.45), and need for hospitalizations (9.4% vs. 3%; P = 0.24). The average total cost of mobilization in the plerixafor group was significantly higher compared to the LD-CY group ($28,980 vs. $19,626.5 P-value < 0.0001). In conclusion, in MM plerixafor-based mobilization has superior efficacy, but significantly higher mobilization costs compared to LD-CY mobilization. Our data caution against the use of LD-CY in MM patients for mobilization, especially after induction with lenalidomide-containing regimens.
authors.affiliation: Section of Hematology and Oncology, West Virginia University, Morgantown, West Virginia.
authors.forename: Lubna
authors.initials: L
authors.lastname: Chaudhary
authors.forename: Farrukh
authors.initials: F
authors.lastname: Awan
authors.forename: Aaron
authors.initials: A
authors.lastname: Cumpston
authors.forename: Sonia
authors.initials: S
authors.lastname: Leadmon
authors.forename: Kathy
authors.initials: K
authors.lastname: Watkins
authors.forename: William
authors.initials: W
authors.lastname: Tse
authors.forename: Michael
authors.initials: M
authors.lastname: Craig
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D018952:Antigens, CD34 / Q000378:metabolism; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics; D001596:Benzylamines; D001897:Boronic Acids / Q000008:administration & dosage / Q000191:economics; D000069286:Bortezomib; D015331:Cohort Studies; D000080027:Cyclams; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000191:economics; D017048:Health Care Costs; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D006571:Heterocyclic Compounds / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D000077269:Lenalidomide; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D011719:Pyrazines / Q000008:administration & dosage / Q000191:economics; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D018952:Antigens, CD34; D000970:Antineoplastic Agents; D001596:Benzylamines; D001897:Boronic Acids; D000080027:Cyclams; D006571:Heterocyclic Compounds; D011719:Pyrazines; D016179:Granulocyte Colony-Stimulating Factor; D013792:Thalidomide; D000069286:Bortezomib; D003520:Cyclophosphamide; D000077269:Lenalidomide; C088327:plerixafor
keywords: bortezomib; cyclophosphamide; lenalidomide; mobilization; multiple myeloma; plerixafor