Abstract
Mobilization of peripheral blood stem cells (PBSC) can be performed using plerixafor, which is expensive, or high-dose cyclophosphamide (HDCy). We hypothesized that the overall cost of mobilization with plerixafor might not be greater if the cost of complication management was considered. We performed a cost analysis of these two strategies. This multicentric observational study recruited patients with myeloma who underwent a first PBSC mobilization. We considered direct medical costs, including hospitalization, mobilization agents, apheresis, and supportive treatments. We included 111 patients, 54 and 57 in the HDCy and plerixafor groups, respectively. Cost of mobilization with HDCy was 5097 ± 2982€ vs. 10958 ± 1789€ for plerixafor (p < 0.0001). Cost of agents used was 1287 ± 779€ vs. 6552 ± 509€, respectively (p = 0.0009). The mean number of days of hospitalization was 2 and 2.1 days, respectively (p = 0.035). All patients achieved the minimum PBSC collection target (p = 1.0); however, ASCT was performed with HDCy in 67% patients and with plerixafor in 86% (p = 0.02). Plerixafor mobilization incurred a greater cost, mostly due to the greater cost of the drug. Hospitalization length in the two groups was similar in our series. Interestingly, plerixafor appeared to be a very effective and safe mobilizing approach translating into a greater ASCT success.
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Acknowledgements
Data management was performed by AXONAL. Authors would like to thank the IFM staff, the centers, patients and their families, and Peter Jenkinson for English editing.
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Conception and design: XL, DC, ED, SL, ZVDW. Conduction of Trial: XL, DC, ED, SL. Collection and assembly of data: MLC, DC, NA LG, PL, MM, JHB, RB, AJ, LK, AB, NM, TS, CG, CG, SG, CD, IP, CT, PM, CH, ED. Data analysis and interpretation: SL, VN. Paper writing: ZVDW, GF, XL, DC, ED, SL, VN.
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LK, PM, CH have no relevant conflict of interest to disclose. XL declares honorarium from Sanofi. ZVDW, VN, GF, MLC, DC, NA, LG, PL, MM, JHB, RB, AJ, AB, NM, TS, CGr, CGi, SG, CD, IP, CT, ED, SL have nothing to disclose.
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Van de Wyngaert, Z., Nerich, V., Fouquet, G. et al. Cost and efficacy of peripheral stem cell mobilization strategies in multiple myeloma. Bone Marrow Transplant 55, 2254–2260 (2020). https://doi.org/10.1038/s41409-020-0940-3
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DOI: https://doi.org/10.1038/s41409-020-0940-3
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