Clinical Impact and Resource Utilization After Stem Cell Mobilization Failure in Patients with Multiple Myeloma and Lymphoma.

Abstract

Abstract 2142Poster Board II-119High-dose chemotherapy in conjunction with autologous SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal stem cell mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of stem cell mobilization attempts at our institution from 2001 through 2007 to determine the frequency of suboptimal mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1,775 patients undergoing mobilization during the study period, stem cell collection (defined by the number of CD34+ cells/kg) was “ optimal” (≥5×106) in 53%, “low” (≥2 to 5×106) in 25%,“ poor” (<2×106) in 10%, and “failed” (<10 CD34+ cells/mL) in 12%. In the 47% of collections that were less than optimal, increased resource consumption included increased use of growth factors and antibiotics, subsequent chemotherapy mobilization, increased transfusional support, more apheresis procedures, and more frequent hospitalization. Other costs often omitted include the need for hospitalization, which was seen in 5% to 11% of the patients in our study. Parenteral antibiotics were needed when fever developed in 7% of patients with Hodgkin disease, 4% with non-Hodgkin lymphoma, and 24% with multiple myeloma who underwent mobilization using a chemotherapy pulse. When stem cell mobilization was not immediately optimal, subsequent attempts to mobilize failed completely in 3 of 42 patients (7%) with Hodgkin disease (3% of the original Hodgkin disease cohort), 56 of 157 (36%) with multiple myeloma (6% of the original myeloma cohort), and 50 of 328 (15%) with non-Hodgkin lymphoma (7% of the original non-Hodgkin lymphoma cohort). These usually unappreciated costs of stem cell mobilization failure highlight the need for more effective mobilization strategies.Table 1Outcome of Collection AttemptsCollection OutcomebDiseaseaHodgkin Disease (n=93)Non-Hodgkin Lymphoma (n=685)Multiple Myeloma (n=997)Optimal (≥5×106)40 (43)199 (29)699 (70)Low (≥2 to <5×106)28 (30)262 (38)162 (16)Poor (<2×106)8 (9)119 (17)48 (5)Failed17 (18)105 (15)88 (9)aValues are No. of patients (%).bOutcome given as number of CD34+ cells/kg.Table 2Prior Therapy in Suboptimal MobilizationsNo. of RegimensbDiseaseaNon-Hodgkin Lymphoma (n=486)Multiple Myeloma (n=298)Hodgkin Disease (n=53)002 (0.4)014 (8)88 (18)173 (58)230 (57)200 (41)80 (27)317 (32)88 (18)24 (8)≥42 (4)108 (22)21 (7)aValues are No. of mobilizations (%).bNo. of primary chemotherapy regimens for the malignancy before attempting to collect stem cells.Table 3Characteristics of Patients With Suboptimal MobilizationCharacteristicDiseaseaHodgkin Disease (n=42)Non-Hodgkin Lymphoma (n=328)Multiple Myeloma (n=157)Male sex21 (50)218 (66)100 (64)Age, y40b (28-49)59b (50-65)63b (57-69)CD34+ cell yield, cells/kgcOptimal (≥5×106)0 (0)0 (0)0 (0)Low (≥2 to <5×106)25 (60)187 (57)100 (64)Poor (<2×106)5 (12)80 (24)19 (12)Failed12 (29)61 (19)38 (24)Prior radiotherapy25 (60)107 (33)66 (42)No. of apheresis rounds3 (0-4)3 (2-4)4b (2-6)No. of prior primary chemotherapy regimens2 (2-3)2 (2-3)1b (1-2)aValues are No. of patients (%) or median (interquartile range).bP<.001.cAfter first suboptimal mobilization attempt. Disclosures:Gertz:genzyme: Research Funding.