Outcomes and costs of autologous stem cell mobilization with chemotherapy plus G-CSF vs G-CSF alone

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Sung, AD; Grima, DT; Bernard, LM; Brown, S; Carrum, G; Holmberg, L; Horwitz, ME; Liesveld, JL; Kanda, J; McClune, B; Shaughnessy, P; Tricot, GJ; Chao, NJ

Published Date

  • November 1, 2013

Published In

Volume / Issue

  • 48 / 11

Start / End Page

  • 1444 - 1449

Electronic International Standard Serial Number (EISSN)

  • 1476-5365

International Standard Serial Number (ISSN)

  • 0268-3369

Digital Object Identifier (DOI)

  • 10.1038/bmt.2013.80

Citation Source

  • Scopus