1. Outcomes and costs of autologous stem cell mobilization with chemotherapy plus G-CSF vs G-CSF alone
- Author
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Guido Tricot, Stephen Brown, Nelson J. Chao, Leona Holmberg, Junya Kanda, Lisa M. Bernard, Paul J. Shaughnessy, Jane L. Liesveld, Mitchell E. Horwitz, Anthony D. Sung, Daniel T. Grima, Brian McClune, and George Carrum
- Subjects
Male ,Lymphoma ,medicine.medical_treatment ,Mobilization ,Hematopoietic stem cell transplantation ,Gastroenterology ,Chemo-mobilization ,Antibodies, Monoclonal, Murine-Derived ,0302 clinical medicine ,Multiple myeloma ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,Granulocyte Colony-Stimulating Factor ,Etoposide ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,Hematopoietic Stem Cell Mobilization ,3. Good health ,Granulocyte colony-stimulating factor ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Rituximab ,medicine.drug ,Adult ,medicine.medical_specialty ,Cyclophosphamide ,G-CSF ,Transplantation, Autologous ,Article ,Young Adult ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Transplantation ,Chemotherapy ,business.industry ,medicine.disease ,Surgery ,Autologous hematopoietic stem cell transplantation ,business ,Febrile neutropenia ,030215 immunology - 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, P0.00001) 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%, P0.05), toxicities and other outcomes were similar. Mobilization with C+G cost significantly more (lymphoma: median $10,300 vs $7300, P0.0001; myeloma: $8800 vs $5600, P0.0001), 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.
- Published
- 2013
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