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

Lubna Chaudhary, Farrukh Awan, Aaron Cumpston, Sonia Leadmon, Kathy Watkins, William Tse, Michael Craig, Mehdi Hamadani

Research output: Contribution to journalArticle

19 Scopus citations

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 × 10 6/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 × 10 6/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.

Original languageEnglish (US)
Pages (from-to)359-367
Number of pages9
JournalJournal of Clinical Apheresis
Volume28
Issue number5
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

Keywords

  • bortezomib
  • cyclophosphamide
  • lenalidomide
  • mobilization
  • multiple myeloma
  • plerixafor

ASJC Scopus subject areas

  • Hematology

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