title: Pharmacoeconomic impact of up-front use of plerixafor for autologous stem cell mobilization in patients with multiple myeloma.
abstract: OBJECTIVE
  Stem cell collection can be a major component of overall cost of autologous stem cell transplantation (ASCT). Plerixafor is an effective agent for mobilization; however, it is often reserved for salvage therapy because of its high cost. We present data on the pharmacoeconomic impact of the use of plerixafor as an up-front mobilization in patients with multiple myeloma (MM).
  
  
  METHODS
  Patients with MM who underwent ASCT between January 2008 and April 2011 at the Mount Sinai Medical Center were reviewed retrospectively. In April 2010, practice changes were instituted for patients with MM to delay initiation of granulocyte-colony-stimulating factor (G-CSF) support from day 0 to day +5 and to add plerixafor to G-CSF as an up-front autologous mobilization. Targets of collection were 5-10 × 10(6) CD34(+) cells/kg.
  
  
  RESULTS
  Of 50 adults with MM who underwent ASCT, 25 received plerixafor/filgrastim and 25 received G-CSF alone as an up-front mobilization. Compared with the control, plerixafor mobilization yielded higher CD34(+) cell content (16.1 versus 8.4 × 10(6) CD34(+) cells/kg; P = 0.0007) and required fewer sessions of apheresis (1.9 versus 3.1; P = 0.0001). In the plerixafor group, the mean number of plerixafor doses required per patient was 1.8. Although the overall cost of medications was higher in the plerixafor group, the cost for blood products and overall cost of hospitalization were similar between the two groups.
  
  
  CONCLUSIONS
  Up-front use of plerixafor is an effective mobilization strategy in patients with MM and does not have a substantial pharmacoeconomic impact in overall cost of hospitalization combined with the apheresis procedure.
authors.affiliation: Department of Pharmacy, The Mount Sinai Medical Center, New York, New York, USA. Electronic address: Sara.Kim@mountsinai.org.
authors.forename: Sara S
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Blood and Marrow Transplantation Program, The Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Anne S
authors.initials: AS
authors.lastname: Renteria
authors.affiliation: Blood and Marrow Transplantation Program, The Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Steinberg
authors.affiliation: Business and Strategic Planning, The Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Banoff
authors.affiliation: Blood and Marrow Transplantation Program, The Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000276:immunology; D001596:Benzylamines; D000080027:Cyclams; D017850:Economics, Pharmaceutical; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006571:Heterocyclic Compounds; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000191:economics / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D014182:Transplantation, Autologous
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; C088327:plerixafor
keywords: autologous stem cell transplantation; mobilization; multiple myeloma; plerixafor; stem cell collection