1
|
Afifi S, Adel NG, Devlin S, Duck E, Vanak J, Landau H, Chung DJ, Lendvai N, Lesokhin A, Korde N, Reich L, Landgren O, Giralt S, Hassoun H. Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study. Bone Marrow Transplant 2016; 51:546-52. [PMID: 26726942 DOI: 10.1038/bmt.2015.322] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/15/2015] [Accepted: 11/08/2015] [Indexed: 12/22/2022]
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.
Collapse
Affiliation(s)
- S Afifi
- Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N G Adel
- Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Duck
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Vanak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - H Landau
- 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
| | - D J Chung
- 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
| | - N Lendvai
- 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
| | - A Lesokhin
- 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
| | - N Korde
- 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
| | - L Reich
- 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
| | - O Landgren
- 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
| | - S Giralt
- 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
| | - H Hassoun
- 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
| |
Collapse
|