title: Hematopoietic progenitor cell mobilization with "just-in-time" plerixafor approach is a cost-effective alternative to routine plerixafor use.
abstract: OBJECTIVE
  Hematopoietic cell mobilization with granulocyte-colony stimulating factor (G-CSF) and plerixafor results in superior CD34+ cell yield compared with G-CSF alone in patients with myeloma and lymphoma. However, plerixafor-based approaches may be associated with high costs. Several institutions use a "just-in-time" plerixafor approach, in which plerixafor is only administered to patients likely to fail mobilization with G-CSF alone. Whether such an approach is cost-effective is unknown.
  
  
  METHODS
  We evaluated 136 patients with myeloma or lymphoma who underwent mobilization with 2 approaches of plerixafor utilization. Between January 2010 and October 2012, 76 patients uniformly received mobilization with G-CSF and plerixafor. Between November 2012 and June 2014, 60 patients were mobilized with plerixafor administered only to those patients likely to fail mobilization with G-CSF alone.
  
  
  RESULTS
  The routine plerixafor group had a higher median peak peripheral blood CD34+ cell count (62 versus 29 cells/μL, P < 0.001) and a higher median day 1 CD34+ yield (2.9 × 10(6) CD34+ cells/kg versus 2.1 × 10(6) CD34+ cells/kg, P = 0.001). The median total CD34+ collection was higher with routine plerixafor use (5.8 × 10(6) CD34+ cells/kg versus 4.5 × 10(6) CD34+ cells/kg, P = 0.007). In the "just-in-time" group, 40% (n = 24) completed adequate collection without plerixafor. There was no difference in mobilization failure rates. The mean plerixafor doses used was lower with "just-in-time" approach (1.3 versus 2.1, P = 0.0002). The mean estimated cost in the routine plerixafor group was higher (USD 27,513 versus USD 23,597, P = 0.01).
  
  
  CONCLUSIONS
  Our analysis demonstrates that mobilization with a just-in-time plerixafor approach is a safe, effective, and cost-efficient strategy for HPC collection.
authors.affiliation: Section of Hematology/Oncology, Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Veltri
authors.affiliation: Department of Pharmacy, West Virginia University, Morgantown, and West Virginia Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cumpston
authors.affiliation: Department of Pharmacy, West Virginia University, Morgantown, and West Virginia Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Shillingburg
authors.affiliation: Department of Biostatistics, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Sijin
authors.initials: S
authors.lastname: Wen
authors.affiliation: Department of Biostatistics, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Jin
authors.initials: J
authors.lastname: Luo
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Leadmon
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Watkins
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Craig
authors.affiliation: Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, West Virginia, USA. Electronic address: askanate@hsc.wvu.edu.
authors.forename: Abraham S
authors.initials: AS
authors.lastname: Kanate
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D001596:Benzylamines; D003362:Cost-Benefit Analysis; D000080027:Cyclams; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000276:immunology / Q000494:pharmacology*; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000378:metabolism; D006571:Heterocyclic Compounds / Q000191:economics / Q000494:pharmacology*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor
keywords: autologous transplantation; cost; just in time; mobilization; plerixafor