期刊
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
卷 19, 期 1, 页码 87-93出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2012.08.010
关键词
Plerixafor; Cost effective analysis; Risk-adapted algorithm; Stem cell mobilization
Historically, up to 30% of patients were unable to collect adequate numbers of peripheral blood stem cells (PBSCs) for autologous stem cell transplantation (ASCT). Plerixafor in combination with granulocyte colony-stimulating factor (G-CSF) has shown superior results in mobilizing peripheral blood (PB) CD34+ cells in comparison to G-CSF alone, but its high cost limits general use. We developed and evaluated risk-adapted algorithms for optimal utilization of plerixafor. In plerixafor-1, PBSC mobilization was commenced with G-CSF alone, and if PB CD34 on day 4 or day 5 was < 10/mu L, plerixafor was administered in the evening, and apheresis commenced the next day. In addition, if on any day, the daily yield was < 0.5 x 10(6) CD34/kg, plerixafor was added. Subsequently, the algorithm was revised (plerixafor-2) with lower thresholds. If day-4 PB CD34 < 10/mu L for single or < 20/mu L for multiple transplantations, or day-1 yield was < 1.5 x 10(6) CD34/kg, or any subsequent daily yield was < 0.5 x 10(6) CD34/kg, plerixafor was added. Three time periods were analyzed for results and associated costs: January to December 2008 (baseline cohort; 319 mobilization attempts in 278 patients); February to November 2009 (plerixafor-1; 221 mobilization attempts in 216 patients); and December 2009 to June 2010 (plerixafor-2; 100 mobilization attempts in 98 patients). Plerixafor-2 shows a significant improvement in PB CD34 collection, increased number of patients reaching minimum and optimal goals, fewer days of apheresis, and fewer days of mobilization/collection, albeit at increased costs. In conclusion, although the earlier identification of ineffective PBSC mobilization and initiation of plerixafor (plerixafor-2) increases the per-patient costs of PBSC mobilization, failure rates, days of apheresis, and total days of mobilization/collection are lower. (C) 2013 American Society for Blood and Marrow Transplantation.
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