title: Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study.
abstract: Cyclophosphamide plus G-CSF (C+G-CSF) is one of the most widely used stem cell (SC) mobilization regimens for patients with multiple myeloma (MM). Plerixafor plus G-CSF (P+G-CSF) has demonstrated superior SC mobilization efficacy when compared with G-CSF alone and has been shown to rescue patients who fail mobilization with G-CSF or C+G-CSF. Despite the proven efficacy of P+G-CSF in upfront SC mobilization, its use has been limited, mostly due to concerns of high price of the drug. However, a comprehensive comparison of the efficacy and cost effectiveness of SC mobilization using C+G-CSF versus P+G-CSF is not available. In this study, we compared 111 patients receiving C+G-CSF to 112 patients receiving P+G-CSF. The use of P+G-CSF was associated with a higher success rate of SC collection defined as ⩾5 × 10(6) CD34+ cells/kg (94 versus 83%, P=0.013) and less toxicities. Thirteen patients in the C+G-CSF arm were hospitalized owing to complications while none in the P+G-CSF group. C+G-CSF was associated with higher financial burden as assessed using institutional-specific costs and charges (P<0.001) as well as using Medicare reimbursement rates (P=0.27). Higher rate of hospitalization, increased need for salvage mobilization, and increased G-CSF use account for these differences.
authors.affiliation: Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Afifi
authors.affiliation: Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: N G
authors.initials: NG
authors.lastname: Adel
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Devlin
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Duck
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Vanak
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: H
authors.initials: H
authors.lastname: Landau
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Chung
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Lendvai
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Lesokhin
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Korde
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Reich
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: O
authors.initials: O
authors.lastname: Landgren
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Giralt
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
authors.forename: H
authors.initials: H
authors.lastname: Hassoun
mesh_terms: D064592:Autografts; D001596:Benzylamines; D003365:Costs and Cost Analysis; D000080027:Cyclams; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics*; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics*; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000191:economics / Q000628:therapy
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; C088327:plerixafor