G-CSF plus preemptive plerixafor vs hyperfractionated CY plus G-CSF for autologous stem cell mobilization in multiple myeloma: effectiveness, safety and cost analysis.
The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) remains undefined. We retrospectively compared our experience in hematopoietic cell mobilization in 83 MM patients using fractionated high-dose CY and G-CSF with G-CSF plus preemptive plerixafor. All patients in the CY group (n=56) received fractionated high-dose CY (5 g/m(2) divided into five doses of 1 g/m(2) every 3 h) with G-CSF. All patients in the plerixafor group (n=27) received G-CSF and plerixafor preemptively based on an established algorithm. Compared with plerixafor, CY use was associated with higher total CD34+ cell yield (7.5 × 10(6) vs 15.5 × 10(6) cells/kg, P=0.005). All patients in both groups yielded ⩾4 × 10(6) CD34+ cells/kg. Conversely, CY use was associated with high frequency of febrile neutropenia, blood and platelet transfusions need and hospitalizations. The average total cost of mobilization in Lebanon was slightly higher in the plerixafor group ($7886 vs $7536; P=0.16). Our data indicate robust stem cell mobilization in MM patients with either fractionated high-dose CY and G-CSF or G-CSF alone with preemptive plerixafor. The chemo-mobilization approach was associated with twofold stem cell yield, slightly lower cost but significantly increased toxicity.
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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A
Antar
Department of Pathology and Immunology, Washington University, Barnes-Jewish Hospital, St Louis, MO, USA.
Z K
ZK
Otrock
Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA.
M A
MA
Kharfan-Dabaja
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
H A
HA
Ghaddara
Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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N
Kreidieh
Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
R
R
Mahfouz
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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A
Bazarbachi
D000328:Adult; D000368:Aged; D064592:Autografts; D001596:Benzylamines; D003365:Costs and Cost Analysis; D000080027:Cyclams; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics*; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics* / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies
D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor