BACKGROUND: Plerixafor (P) reduces mobilization failure rates but it is very expensive. For better utilization of P, we employed a risk-adaptive strategy of using it only in patients who are at high risk of mobilization failure, defined by peripheral blood (PB) CD34+ cell count of fewer than 10×10(6)/L after 4 days of filgrastim (F) alone. STUDY DESIGN AND METHODS: Herein, we present the results of efficacy and cost-benefit analysis of this risk-adaptive approach for hematopoietic progenitor cell (HPC) collection. All patients received daily F for 4 days, and P was added for those "at-risk" patients from Day 4 with apheresis commencing the following morning. F and P were continued daily for up to a maximum of 4 days or until more than 5×10(6) CD34+ cells/kg were collected. Forty-two transplant-eligible patients underwent HPC mobilization. RESULTS: Eighteen patients mobilized with F alone and 24 patients required P with F. Two patients failed adequate HPC mobilization after F+P. Addition of P increased the PB CD34+ count by 6.8-fold with a mean yield of 4.9×10(6) CD34+ cells/kg. Decision-analysis model estimated cost-effectiveness for this risk-adaptive approach of using P with savings of $19,300/patient. Engraftment after HPC infusion was similar among the patients regardless of mobilization regimens. CONCLUSION: These results suggest that addition of P to F based on a risk-adaptive strategy significantly reduces the frequency of mobilization failures and is also cost-effective.
BACKGROUND:Plerixafor (P) reduces mobilization failure rates but it is very expensive. For better utilization of P, we employed a risk-adaptive strategy of using it only in patients who are at high risk of mobilization failure, defined by peripheral blood (PB) CD34+ cell count of fewer than 10×10(6)/L after 4 days of filgrastim (F) alone. STUDY DESIGN AND METHODS: Herein, we present the results of efficacy and cost-benefit analysis of this risk-adaptive approach for hematopoietic progenitor cell (HPC) collection. All patients received daily F for 4 days, and P was added for those "at-risk" patients from Day 4 with apheresis commencing the following morning. F and P were continued daily for up to a maximum of 4 days or until more than 5×10(6) CD34+ cells/kg were collected. Forty-two transplant-eligible patients underwent HPC mobilization. RESULTS: Eighteen patients mobilized with F alone and 24 patients required P with F. Two patients failed adequate HPC mobilization after F+P. Addition of P increased the PB CD34+ count by 6.8-fold with a mean yield of 4.9×10(6) CD34+ cells/kg. Decision-analysis model estimated cost-effectiveness for this risk-adaptive approach of using P with savings of $19,300/patient. Engraftment after HPC infusion was similar among the patients regardless of mobilization regimens. CONCLUSION: These results suggest that addition of P to F based on a risk-adaptive strategy significantly reduces the frequency of mobilization failures and is also cost-effective.
Authors: Lauren Veltri; Aaron Cumpston; Alexandra Shillingburg; Sijin Wen; Jin Luo; Sonia Leadmon; Kathy Watkins; Michael Craig; Mehdi Hamadani; Abraham S Kanate Journal: Cytotherapy Date: 2015-10-21 Impact factor: 5.414
Authors: A Antar; Z K Otrock; M A Kharfan-Dabaja; H A Ghaddara; N Kreidieh; R Mahfouz; A Bazarbachi Journal: Bone Marrow Transplant Date: 2015-03-09 Impact factor: 5.483
Authors: M E Horwitz; J P Chute; C Gasparetto; G D Long; C McDonald; A Morris; D A Rizzieri; K M Sullivan; N J Chao Journal: Bone Marrow Transplant Date: 2011-11-14 Impact factor: 5.483
Authors: A D Sung; D T Grima; L M Bernard; S Brown; G Carrum; L Holmberg; M E Horwitz; J L Liesveld; J Kanda; B McClune; P Shaughnessy; G J Tricot; N J Chao Journal: Bone Marrow Transplant Date: 2013-06-10 Impact factor: 5.483
Authors: R E Clark; J Bell; J O Clark; B Braithwaite; U Vithanarachchi; N McGinnity; T Callaghan; S Francis; R Salim Journal: Blood Cancer J Date: 2014-10-31 Impact factor: 11.037