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Mesquita Augusto Passos R, Feldens TK, Marcolino MAZ, Gouvêa AS, Dos Santos Oliveira L, Menardi Nasser L, Rodrigues RF, de Lourdes Martins Perobelli L, Campolina AG, de Almeida Neto C. Economic evaluation of plerixafor addition in the mobilization and leukapheresis of hematopoietic stem cells for autologous transplantation: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:15-28. [PMID: 36285481 DOI: 10.1080/14737167.2023.2140140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Although plerixafor in association with granulocyte colony-stimulating factor (G-CSF) can improve mobilization and collection of hematopoietic stem cells (HSC) by leukapheresis, cost may limit its clinical application. The present study systematically reviews economic evaluations of plerixafor plus G-CSF usage compared to G-CSF alone and compares different strategies of plerixafor utilization in multiple myeloma and lymphoma patients eligible for autologous HSC transplantation. AREAS COVERED Relevant economic evaluations, partial or complete, were searched on PubMed, Embase, LILACS, and Cochrane Central Register of Controlled Trials for a period ending 30 June 2021. This systematic review was reported following the PRISMA Statement. Six economic evaluations were included, considering the use of upfront or just-in-time plerixafor compared to G-CSF alone or other plerixafor strategies. Most comparisons showed both increased cost and health benefits with the addition of plerixafor. Most analyses favored just-in-time plerixafor compared to upfront plerixafor, with a probable preference for broader cutoffs for just-in-time plerixafor initiation. EXPERT OPINION Plerixafor is a potentially cost-effective technology in the mobilization of HSC in patients with multiple myeloma and lymphomas eligible for autologous HSC transplantation. There is a decreased number of leukapheresis sessions and remobilizations and a higher yield of CD34+ cells.
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Affiliation(s)
- Roselene Mesquita Augusto Passos
- Departamento de Transplante de Medula Óssea, Hematologia, Hospital de Transplantes Euryclides de Jesus Zerbini, São Paulo, Brazil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Departamento de Hematologia e Hemoterapia, Dasa-Hospital 9 de Julho, São Paulo, Brazil
| | - Tallys Kalynka Feldens
- Programa de Pós-Graduação em Desenvolvimento Econômico, Universidade Federal do Paraná, Paraná, Brazil.,Departamento Financeiro, Secretaria de Estado da Saúde do Paraná, Paraná, Brazil
| | - Miriam Allein Zago Marcolino
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil.,Instituto para Avaliação de Tecnologia em Saúde - INCT/IATS (CNPQ 465518/2014-1), Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | | | | | - Luisa Menardi Nasser
- Departamento de Hematologia e Hemoterapia, Dasa-Hospital 9 de Julho, São Paulo, Brazil
| | - Roseli Fernandes Rodrigues
- Núcleo de Ensino e Pesquisa / Núcleo de Avaliação de Tecnologias em Saúde, Hospital de Transplantes Euryclides de Jesus Zerbini, São Paulo, Brazil
| | | | | | - Cesar de Almeida Neto
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Departamento de Hematologia e Hemoterapia, Dasa-Hospital 9 de Julho, São Paulo, Brazil.,Departamento de Aféreses, Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
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Kurnikova E, Trakhtman P, Balashov D, Garloeva J, Kumukova I, Khismatullina R, Pershin D, Shelikhova L, Novichkova G, Maschan A. Efficacy and safety of a reduced dose of plerixafor in combination with granulocyte colony-stimulating factor in healthy haploidentical stem cell donors. Vox Sang 2022; 117:853-861. [PMID: 35332550 DOI: 10.1111/vox.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Implementation of the technique of immunomagnetic selection requires the procurement of a large number of CD34+ cells from haploidentical donors within a single apheresis procedure. The release of stem cells with granulocyte colony-stimulating factor (G-CSF) alone is unsatisfactory in a number of donors, and plerixafor, a CXCR4 chemokine receptor antagonist, could be used as an additional mobilization agent. The aim of our study was to examine whether a lower dose of plerixafor (0.12 mg/kg) can provide sufficient increase in CD34+ cells in the peripheral blood of allogeneic healthy donors in comparison with a historical control group. In addition, we assessed the risk of inability to provide the recipient with a transplant containing the optimal dose of 8-10 × 106 CD34+ cells/kg body weight of the recipient. MATERIALS AND METHODS In a prospective, single-arm study, we examined the results of 105 mobilizations in healthy adult haploidentical donors with G-CSF and plerixafor at a dose of 0.12 mg/kg. The historical control group consisted of 106 mobilizations with G-CSF and plerixafor at 0.24 mg/kg. RESULTS The median increase in the number of CD34+ cells from day 4 to day 5 of mobilization was 69 cells/μl (range, 28-240) versus 77 cells/μl (24-217) in the groups of 0.12 and 0.24 mg/kg of plerixafor, respectively (p-value 0.255). The apheresis products contained a median of 14.4 × 106 /kg recipient body weight CD34+ cells versus 12.9 × 106 /kg in the groups that received 0.12 and 0.24 mg/kg of plerixafor, respectively (p-value 0.118). The obtained differences were not significant, which means the application of a decreased dose of plerixafor did not affect the results of mobilization. CONCLUSION The obtained differences in collection were not significant, and thus the application of a decreased dose of plerixafor did not affect the results of mobilization.
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Affiliation(s)
- Elena Kurnikova
- Transfusion Medicine Service, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Pavel Trakhtman
- Transfusion Medicine Service, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Dmitry Balashov
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Juliya Garloeva
- Transfusion Medicine Service, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Irina Kumukova
- Transfusion Medicine Service, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Rimma Khismatullina
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Dmitriy Pershin
- Transplantation Immunology and Immunotherapy Laboratory, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Larisa Shelikhova
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Galina Novichkova
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexey Maschan
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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