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Rescue stem cell mobilization with plerixafor economizes leukapheresis in patients with multiple myeloma
Author(s) -
Hundemer Michael,
Engelhardt Melanie,
Bruckner Thomas,
Kraeker Sandra,
Schmitt Anita,
Sauer Sandra,
Neben Kai,
WitzensHarig Mathias,
Goldschmidt Hartmut,
Ho Anthony D.,
Wuchter Patrick
Publication year - 2014
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21323
Subject(s) - plerixafor , leukapheresis , medicine , multiple myeloma , apheresis , surgery , stem cell , granulocyte colony stimulating factor , autologous stem cell transplantation , mobilization , cd34 , chemotherapy , cxcr4 , platelet , history , chemokine , receptor , archaeology , biology , genetics
While extensive data demonstrated that plerixafor improves stem cell harvest in difficult‐to‐mobilize patients, economic concerns limit a broader application. We retrospectively assessed the effect of an early plerixafor rescue regimen for mobilization in patients with multiple myeloma. Patients were intended for high‐dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ABSCT) and therefore received cyclophosphamide‐based mobilization chemotherapy and consecutive stimulation with granulocyte colony‐stimulating factor (G‐CSF). Fifteen patients with poor stem cell harvest in the first leukapheresis session received plerixafor. Data were compared with a matched historic control group of 45 patients who also had a poor stem cell yield in the first apheresis session, but continued mobilization with G‐CSF alone. Patients in the plerixafor group collected significantly more CD34+ cells in total (median 4.9 vs. 3.7 [range 1.6–14.1 vs. 1.1–8.0] × 10 6 CD34+ cells /kg bw; P < 0.05), and also more CD34+ cells per leukapheresis procedure ( P < 0.001). Consequently, they required a significantly lower number of leukapheresis procedures to achieve the collection goal (median 2.0 vs. 4.0 [range 2–3 vs. 2–9] procedures; P < 0.001). The efficiency of the collected stem cells in terms of hematologic engraftment after ABSCT was found to be equal in both groups. These data demonstrate that rescue mobilization with plerixafor triggered by a low stem cell yield in the first leukapheresis session is effective. Although the actual economic benefit may vary depending on the local leukapheresis costs, the median saving of two leukapheresis procedures offsets most of the expenses for the substance in this setting. An exemplary cost calculation is provided to illustrate this effect. J. Clin. Apheresis 29:299–304 2014. © 2014 Wiley Periodicals, Inc.