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Outcomes and costs of autologous stem cell mobilization with chemotherapy plus G-CSF vs G-CSF alone
A D Sung1, D T Grima, L M Bernard
1Divison of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, NC, USA.
Insights
Chemotherapy plus G-CSF (C+G) is effective for mobilizing CD34(+) cells for autologous hematopoietic stem cell transplant (AHSCT). While C+G yields more cells and requires fewer apheresis days, it incurs higher costs, suggesting cost-effectiveness for high-risk patients.
Area of Science:
- Hematology
- Oncology
- Transplant Medicine
Background:
- Autologous hematopoietic stem cell transplant (AHSCT) relies on effective mobilization of CD34(+) cells.
- Chemotherapy plus G-CSF (C+G) and G-CSF alone are standard mobilization strategies.
Purpose of the Study:
- To compare the real-world outcomes and costs of C+G versus G-CSF alone for CD34(+) cell mobilization in AHSCT.
- To evaluate the efficacy and safety of these two mobilization strategies across different patient populations.
Main Methods:
- Retrospective study of 226 patients (64 lymphoma, 162 multiple myeloma) across 11 medical centers.
- Comparison of CD34(+) cell yield, apheresis duration, toxicity, and costs between C+G and G-CSF alone groups.
Main Results:
- C+G mobilization resulted in significantly higher daily CD34(+) cell yields and fewer apheresis days for both lymphoma and myeloma patients.
- Toxicity profiles were similar, except for a higher rate of febrile neutropenia in myeloma patients receiving C+G.
- Mobilization with C+G was associated with significantly higher costs compared to G-CSF alone.
Conclusions:
- Both C+G and G-CSF alone are effective for CD34(+) cell mobilization in AHSCT.
- C+G may offer a cost-effective advantage for patients at high risk of insufficient stem cell mobilization, despite higher upfront costs.
Abstract:
Chemotherapy plus G-CSF (C+G) and G-CSF alone are two of the most common methods used to mobilize CD34(+) cells for autologous hematopoietic SCT (AHSCT). In order to compare and determine the real-world outcomes and costs of these strategies, we performed a retrospective study of 226 consecutive patients at 11 medical centers (64 lymphoma, 162 multiple myeloma), of whom 55% of lymphoma patients and 66% of myeloma patients received C+G. Patients with C+G yielded more CD34(+) cells/day than those with G-CSF alone (lymphoma: average 5.51 × 10(6) cells/kg on day 1 vs 2.92 × 10(6) cells/kg, P=0.0231; myeloma: 4.16 × 10(6) vs 3.69 × 10(6) cells/kg, P<0.00001) and required fewer days of apheresis (lymphoma: average 2.11 vs 2.96 days, P=0.012; myeloma: 2.02 vs 2.83 days, P=0.0015), although nearly all patients ultimately reached the goal of 2 × 10(6) cells/kg. With the exception of higher rates of febrile neutropenia in myeloma patients with C+G (17% vs 2%, P<0.05), toxicities and other outcomes were similar. Mobilization with C+G cost significantly more (lymphoma: median $10,300 vs $7300, P<0.0001; myeloma: $8800 vs $5600, P<0.0001), although re-mobilization adds $6700 for drugs alone. Our results suggest that although both C+G and G-CSF alone are effective mobilization strategies, C+G may be more cost-effective for patients at high risk of insufficient mobilization.
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