Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy-era with plerixafor and G-CSF has superior efficacy but significantly higher costs compared to mobilization with low-dose cyclophosphamide and G-CSF
Studies comparing the efficacy and cost of peripheral blood stem and progenitor cells mobilization with low‐dose cyclophosphamide (LD‐CY) and granulocyte‐colony stimulating factor (G‐CSF) against plerixafor and G‐CSF, in multiple myeloma (MM) patients treated in the novel therapy‐era are not availab...
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description | Studies comparing the efficacy and cost of peripheral blood stem and progenitor cells mobilization with low‐dose cyclophosphamide (LD‐CY) and granulocyte‐colony stimulating factor (G‐CSF) against plerixafor and G‐CSF, in multiple myeloma (MM) patients treated in the novel therapy‐era are not available. Herein, we report mobilization outcomes of 107 patients who underwent transplantation within 1‐year of starting induction chemotherapy with novel agents. Patients undergoing mobilization with LD‐CY (1.5 gm/m2) and G‐CSF (n = 74) were compared against patients receiving plerixafor and G‐CSF (n = 33). Compared to plerixafor, LD‐CY was associated with a significantly lower median peak peripheral blood CD34+ cell count (68/µL vs. 36/µL, P = 0.048), and lower CD34+ cell yield on day 1 of collection (6.9 × 106/kg vs. 2.4 × 106/kg, P = 0.001). Six patients (8.1%) in the LD‐CY group experienced mobilization failure, compared to none in the plerixafor group. The total CD34+ cell yield was significantly higher in the plerixafor group (median 11.6 × 106/kg vs. 7 × 106/kg; P‐value = 0.001). Mobilization with LD‐CY was associated with increased (albeit statistically non‐significant) episodes of febrile neutropenia (5.4% vs. 0%; P = 0.24), higher use of intravenous antibiotics (6.7% vs. 3%; P = 0.45), and need for hospitalizations (9.4% vs. 3%; P = 0.24). The average total cost of mobilization in the plerixafor group was significantly higher compared to the LD‐CY group ($28,980 vs. $19,626.5 P‐value |
doi_str_mv | 10.1002/jca.21280 |
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Herein, we report mobilization outcomes of 107 patients who underwent transplantation within 1‐year of starting induction chemotherapy with novel agents. Patients undergoing mobilization with LD‐CY (1.5 gm/m2) and G‐CSF (n = 74) were compared against patients receiving plerixafor and G‐CSF (n = 33). Compared to plerixafor, LD‐CY was associated with a significantly lower median peak peripheral blood CD34+ cell count (68/µL vs. 36/µL, P = 0.048), and lower CD34+ cell yield on day 1 of collection (6.9 × 106/kg vs. 2.4 × 106/kg, P = 0.001). Six patients (8.1%) in the LD‐CY group experienced mobilization failure, compared to none in the plerixafor group. The total CD34+ cell yield was significantly higher in the plerixafor group (median 11.6 × 106/kg vs. 7 × 106/kg; P‐value = 0.001). Mobilization with LD‐CY was associated with increased (albeit statistically non‐significant) episodes of febrile neutropenia (5.4% vs. 0%; P = 0.24), higher use of intravenous antibiotics (6.7% vs. 3%; P = 0.45), and need for hospitalizations (9.4% vs. 3%; P = 0.24). The average total cost of mobilization in the plerixafor group was significantly higher compared to the LD‐CY group ($28,980 vs. $19,626.5 P‐value < 0.0001). In conclusion, in MM plerixafor‐based mobilization has superior efficacy, but significantly higher mobilization costs compared to LD‐CY mobilization. Our data caution against the use of LD‐CY in MM patients for mobilization, especially after induction with lenalidomide‐containing regimens. J. Clin. Apheresis 28:359–367, 2013. © 2013 Wiley Periodicals, Inc.</description><identifier>ISSN: 0733-2459</identifier><identifier>EISSN: 1098-1101</identifier><identifier>DOI: 10.1002/jca.21280</identifier><identifier>PMID: 23765597</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject><![CDATA[Adult ; Aged ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - economics ; Antigens, CD34 - metabolism ; Antineoplastic Agents - administration & dosage ; Antineoplastic Agents - economics ; Boronic Acids - administration & dosage ; Boronic Acids - economics ; Bortezomib ; Cohort Studies ; cyclophosphamide ; Cyclophosphamide - administration & dosage ; Cyclophosphamide - economics ; Female ; Granulocyte Colony-Stimulating Factor - administration & dosage ; Granulocyte Colony-Stimulating Factor - economics ; Health Care Costs ; Hematopoietic Stem Cell Mobilization - economics ; Hematopoietic Stem Cell Mobilization - methods ; Heterocyclic Compounds - administration & dosage ; Heterocyclic Compounds - economics ; Humans ; Lenalidomide ; Leukocytes, Mononuclear - cytology ; Male ; Middle Aged ; mobilization ; multiple myeloma ; Multiple Myeloma - therapy ; Peripheral Blood Stem Cell Transplantation - methods ; plerixafor ; Pyrazines - administration & dosage ; Pyrazines - economics ; Thalidomide - administration & dosage ; Thalidomide - analogs & derivatives ; Thalidomide - economics ; Time Factors ; Transplantation Conditioning - methods ; Treatment Outcome]]></subject><ispartof>Journal of clinical apheresis, 2013-10, Vol.28 (5), p.359-367</ispartof><rights>Copyright © 2013 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3910-d64e5dd88c8aef3243696bda0dd502a4db2b6d1200354036292dd49f085af78c3</citedby><cites>FETCH-LOGICAL-c3910-d64e5dd88c8aef3243696bda0dd502a4db2b6d1200354036292dd49f085af78c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjca.21280$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjca.21280$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23765597$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chaudhary, Lubna</creatorcontrib><creatorcontrib>Awan, Farrukh</creatorcontrib><creatorcontrib>Cumpston, Aaron</creatorcontrib><creatorcontrib>Leadmon, Sonia</creatorcontrib><creatorcontrib>Watkins, Kathy</creatorcontrib><creatorcontrib>Tse, William</creatorcontrib><creatorcontrib>Craig, Michael</creatorcontrib><creatorcontrib>Hamadani, Mehdi</creatorcontrib><title>Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy-era with plerixafor and G-CSF has superior efficacy but significantly higher costs compared to mobilization with low-dose cyclophosphamide and G-CSF</title><title>Journal of clinical apheresis</title><addtitle>J. Clin. Apheresis</addtitle><description>Studies comparing the efficacy and cost of peripheral blood stem and progenitor cells mobilization with low‐dose cyclophosphamide (LD‐CY) and granulocyte‐colony stimulating factor (G‐CSF) against plerixafor and G‐CSF, in multiple myeloma (MM) patients treated in the novel therapy‐era are not available. Herein, we report mobilization outcomes of 107 patients who underwent transplantation within 1‐year of starting induction chemotherapy with novel agents. Patients undergoing mobilization with LD‐CY (1.5 gm/m2) and G‐CSF (n = 74) were compared against patients receiving plerixafor and G‐CSF (n = 33). Compared to plerixafor, LD‐CY was associated with a significantly lower median peak peripheral blood CD34+ cell count (68/µL vs. 36/µL, P = 0.048), and lower CD34+ cell yield on day 1 of collection (6.9 × 106/kg vs. 2.4 × 106/kg, P = 0.001). Six patients (8.1%) in the LD‐CY group experienced mobilization failure, compared to none in the plerixafor group. The total CD34+ cell yield was significantly higher in the plerixafor group (median 11.6 × 106/kg vs. 7 × 106/kg; P‐value = 0.001). Mobilization with LD‐CY was associated with increased (albeit statistically non‐significant) episodes of febrile neutropenia (5.4% vs. 0%; P = 0.24), higher use of intravenous antibiotics (6.7% vs. 3%; P = 0.45), and need for hospitalizations (9.4% vs. 3%; P = 0.24). The average total cost of mobilization in the plerixafor group was significantly higher compared to the LD‐CY group ($28,980 vs. $19,626.5 P‐value < 0.0001). In conclusion, in MM plerixafor‐based mobilization has superior efficacy, but significantly higher mobilization costs compared to LD‐CY mobilization. Our data caution against the use of LD‐CY in MM patients for mobilization, especially after induction with lenalidomide‐containing regimens. J. Clin. Apheresis 28:359–367, 2013. © 2013 Wiley Periodicals, Inc.</description><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - economics</subject><subject>Antigens, CD34 - metabolism</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Antineoplastic Agents - economics</subject><subject>Boronic Acids - administration & dosage</subject><subject>Boronic Acids - economics</subject><subject>Bortezomib</subject><subject>Cohort Studies</subject><subject>cyclophosphamide</subject><subject>Cyclophosphamide - administration & dosage</subject><subject>Cyclophosphamide - economics</subject><subject>Female</subject><subject>Granulocyte Colony-Stimulating Factor - administration & dosage</subject><subject>Granulocyte Colony-Stimulating Factor - economics</subject><subject>Health Care Costs</subject><subject>Hematopoietic Stem Cell Mobilization - economics</subject><subject>Hematopoietic Stem Cell Mobilization - methods</subject><subject>Heterocyclic Compounds - administration & dosage</subject><subject>Heterocyclic Compounds - economics</subject><subject>Humans</subject><subject>Lenalidomide</subject><subject>Leukocytes, Mononuclear - cytology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mobilization</subject><subject>multiple myeloma</subject><subject>Multiple Myeloma - therapy</subject><subject>Peripheral Blood Stem Cell Transplantation - methods</subject><subject>plerixafor</subject><subject>Pyrazines - administration & dosage</subject><subject>Pyrazines - economics</subject><subject>Thalidomide - administration & dosage</subject><subject>Thalidomide - analogs & derivatives</subject><subject>Thalidomide - economics</subject><subject>Time Factors</subject><subject>Transplantation Conditioning - methods</subject><subject>Treatment Outcome</subject><issn>0733-2459</issn><issn>1098-1101</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctu1DAYhSMEoqWw4AXQL7FikdaX3LwsIzqAykXi0qXl2E7jwYlT22EanpsHwNNpi1iw8e3_zjmWTpY9x-gYI0RONlIcE0wa9CA7xIg1OcYIP8wOUU1pToqSHWRPQtgghBij5ePsgNC6KktWH2a_P2tvpl57YaG1zikIUQ8gtbUwuNZY80tE40YwIwyzjWayGoZFWzcImNJIjzFA9FrEHRJ7DaP7qe3u5MW05GmFrYk9JKE316JzHsSoYJ2vvpxBLwKEeUqT9Ky7zkghF2jnCMFcjmZ3H6NdoDeXyQ-kCylNumESXiuI7t8_3uRYt82VCxrkIq2behemXgxG6b-xT7NHnbBBP7vdj7JvZ2--rt7m55_W71an57mkDKNcVYUulWoa2QjdUVLQilWtEkipEhFRqJa0lcIEIVoWiFaEEaUK1qGmFF3dSHqUvdz7Tt5dzTpEvnGzH1Mkx0WBq6pqapKoV3tKeheC1x2fvBmEXzhGfNcvT_3ym34T--LWcW4Hre7Ju0ITcLIHtsbq5f9O_P3q9M4y3ytMav76XiH8D17VtC75xcc1Z_jD95JdYP6a_gF-JsQT</recordid><startdate>201310</startdate><enddate>201310</enddate><creator>Chaudhary, Lubna</creator><creator>Awan, Farrukh</creator><creator>Cumpston, Aaron</creator><creator>Leadmon, Sonia</creator><creator>Watkins, Kathy</creator><creator>Tse, William</creator><creator>Craig, Michael</creator><creator>Hamadani, Mehdi</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope></search><sort><creationdate>201310</creationdate><title>Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy-era with plerixafor and G-CSF has superior efficacy but significantly higher costs compared to mobilization with low-dose cyclophosphamide and G-CSF</title><author>Chaudhary, Lubna ; Awan, Farrukh ; Cumpston, Aaron ; Leadmon, Sonia ; Watkins, Kathy ; Tse, William ; Craig, Michael ; Hamadani, Mehdi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3910-d64e5dd88c8aef3243696bda0dd502a4db2b6d1200354036292dd49f085af78c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - economics</topic><topic>Antigens, CD34 - metabolism</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Antineoplastic Agents - economics</topic><topic>Boronic Acids - administration & dosage</topic><topic>Boronic Acids - economics</topic><topic>Bortezomib</topic><topic>Cohort Studies</topic><topic>cyclophosphamide</topic><topic>Cyclophosphamide - administration & dosage</topic><topic>Cyclophosphamide - economics</topic><topic>Female</topic><topic>Granulocyte Colony-Stimulating Factor - administration & dosage</topic><topic>Granulocyte Colony-Stimulating Factor - economics</topic><topic>Health Care Costs</topic><topic>Hematopoietic Stem Cell Mobilization - economics</topic><topic>Hematopoietic Stem Cell Mobilization - methods</topic><topic>Heterocyclic Compounds - administration & dosage</topic><topic>Heterocyclic Compounds - economics</topic><topic>Humans</topic><topic>Lenalidomide</topic><topic>Leukocytes, Mononuclear - cytology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mobilization</topic><topic>multiple myeloma</topic><topic>Multiple Myeloma - therapy</topic><topic>Peripheral Blood Stem Cell Transplantation - methods</topic><topic>plerixafor</topic><topic>Pyrazines - administration & dosage</topic><topic>Pyrazines - economics</topic><topic>Thalidomide - administration & dosage</topic><topic>Thalidomide - analogs & derivatives</topic><topic>Thalidomide - economics</topic><topic>Time Factors</topic><topic>Transplantation Conditioning - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chaudhary, Lubna</creatorcontrib><creatorcontrib>Awan, Farrukh</creatorcontrib><creatorcontrib>Cumpston, Aaron</creatorcontrib><creatorcontrib>Leadmon, Sonia</creatorcontrib><creatorcontrib>Watkins, Kathy</creatorcontrib><creatorcontrib>Tse, William</creatorcontrib><creatorcontrib>Craig, Michael</creatorcontrib><creatorcontrib>Hamadani, Mehdi</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>Journal of clinical apheresis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaudhary, Lubna</au><au>Awan, Farrukh</au><au>Cumpston, Aaron</au><au>Leadmon, Sonia</au><au>Watkins, Kathy</au><au>Tse, William</au><au>Craig, Michael</au><au>Hamadani, Mehdi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy-era with plerixafor and G-CSF has superior efficacy but significantly higher costs compared to mobilization with low-dose cyclophosphamide and G-CSF</atitle><jtitle>Journal of clinical apheresis</jtitle><addtitle>J. Clin. Apheresis</addtitle><date>2013-10</date><risdate>2013</risdate><volume>28</volume><issue>5</issue><spage>359</spage><epage>367</epage><pages>359-367</pages><issn>0733-2459</issn><eissn>1098-1101</eissn><abstract>Studies comparing the efficacy and cost of peripheral blood stem and progenitor cells mobilization with low‐dose cyclophosphamide (LD‐CY) and granulocyte‐colony stimulating factor (G‐CSF) against plerixafor and G‐CSF, in multiple myeloma (MM) patients treated in the novel therapy‐era are not available. Herein, we report mobilization outcomes of 107 patients who underwent transplantation within 1‐year of starting induction chemotherapy with novel agents. Patients undergoing mobilization with LD‐CY (1.5 gm/m2) and G‐CSF (n = 74) were compared against patients receiving plerixafor and G‐CSF (n = 33). Compared to plerixafor, LD‐CY was associated with a significantly lower median peak peripheral blood CD34+ cell count (68/µL vs. 36/µL, P = 0.048), and lower CD34+ cell yield on day 1 of collection (6.9 × 106/kg vs. 2.4 × 106/kg, P = 0.001). Six patients (8.1%) in the LD‐CY group experienced mobilization failure, compared to none in the plerixafor group. The total CD34+ cell yield was significantly higher in the plerixafor group (median 11.6 × 106/kg vs. 7 × 106/kg; P‐value = 0.001). Mobilization with LD‐CY was associated with increased (albeit statistically non‐significant) episodes of febrile neutropenia (5.4% vs. 0%; P = 0.24), higher use of intravenous antibiotics (6.7% vs. 3%; P = 0.45), and need for hospitalizations (9.4% vs. 3%; P = 0.24). The average total cost of mobilization in the plerixafor group was significantly higher compared to the LD‐CY group ($28,980 vs. $19,626.5 P‐value < 0.0001). In conclusion, in MM plerixafor‐based mobilization has superior efficacy, but significantly higher mobilization costs compared to LD‐CY mobilization. Our data caution against the use of LD‐CY in MM patients for mobilization, especially after induction with lenalidomide‐containing regimens. J. Clin. Apheresis 28:359–367, 2013. © 2013 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>23765597</pmid><doi>10.1002/jca.21280</doi><tpages>9</tpages></addata></record> |
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subjects | Adult Aged Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - economics Antigens, CD34 - metabolism Antineoplastic Agents - administration & dosage Antineoplastic Agents - economics Boronic Acids - administration & dosage Boronic Acids - economics Bortezomib Cohort Studies cyclophosphamide Cyclophosphamide - administration & dosage Cyclophosphamide - economics Female Granulocyte Colony-Stimulating Factor - administration & dosage Granulocyte Colony-Stimulating Factor - economics Health Care Costs Hematopoietic Stem Cell Mobilization - economics Hematopoietic Stem Cell Mobilization - methods Heterocyclic Compounds - administration & dosage Heterocyclic Compounds - economics Humans Lenalidomide Leukocytes, Mononuclear - cytology Male Middle Aged mobilization multiple myeloma Multiple Myeloma - therapy Peripheral Blood Stem Cell Transplantation - methods plerixafor Pyrazines - administration & dosage Pyrazines - economics Thalidomide - administration & dosage Thalidomide - analogs & derivatives Thalidomide - economics Time Factors Transplantation Conditioning - methods Treatment Outcome |
title | Peripheral blood stem cell mobilization in multiple myeloma patients treat in the novel therapy-era with plerixafor and G-CSF has superior efficacy but significantly higher costs compared to mobilization with low-dose cyclophosphamide and G-CSF |
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