Utilization of stored autologous PBSCs to support second autologous transplantation in multiple myeloma patients in the era of novel agent therapy.
Outcomes in multiple myeloma (MM) have improved significantly with novel agent therapy and autologous stem cell transplantation (ASCT). ASCTs are typically planned as either tandem or a single transplant with additional stored PBSCs available for a second salvage transplant. To accommodate these strategies, many centers routinely collect and store adequate PBSCs for two ASCTs. We analyzed the cost associated with this practice by determining the expenses of PBSC collection, cryopreservation and storage, and the ultimate use of additional cryopreserved PBSCs in patients who had undergone at least one ASCT. There were 889 MM patients transplanted between 1993 and 2011 at our center. Most (N=726) had residual PBSCs in storage after their first ASCT (ASCT1). Only 135 patients underwent a second ASCT within a median of 14 months after ASCT1. The percentage of patients receiving a second ASCT declined over time. The resources required to collect and store unused PBSCs added up to 336 extra patient days of apheresis and 41 587 extra patient months of cryopreservation, translating into an average extra cost per patient of US$4981.12. A reconsideration of conventional PBSC collection and storage practices would save significant cost for the majority of MM patients who never undergo a second ASCT.
1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Department of Haematology, Singapore General Hospital, Singapore, Singapore.
C
C
Phipps
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
M
M
Linenberger
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
L A
LA
Holmberg
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
D
D
Green
Department of Medicine, University of Washington, Seattle, WA, USA.
P
P
Becker
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
L
L
Connelly-Smith
Amgen Inc., Thousand Oaks, CA, USA.
Z
Z
Klippel
Medical Oncology, University of Washington, Seattle, WA, USA.
N
N
Burwick
1] Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] Medical Oncology, University of Washington, Seattle, WA, USA.
A
A
Gopal
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
W I
WI
Bensinger
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
E
E
Libby
D000328:Adult; D000368:Aged; D064592:Autografts; D001781:Blood Component Removal / Q000191:economics / Q000379:methods; D003365:Costs and Cost Analysis; D015925:Cryopreservation / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000191:economics / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation / Q000191:economics / Q000379:methods; D012189:Retrospective Studies