Abstract
7040 Background: Efficacy and cost effectiveness of P vs. LD-CY mobilization in MM pts treated with novel induction therapies is not known. Methods: We analyzed the mobilization outcomes of 107 consecutive pts who underwent a planned, single autograft within 1-year of starting induction therapy with novel agents (thalidomide, lenalidomide, bortezomib) between 2003-2012. Pts undergoing mobilization with LD-CY/G-CSF (1.5gm/m2) (n=74) were compared against those receiving P/G-CSF (0.24mg/kg) (n=33). Efficacy of PBSC mobilization was assessed by evaluating peak peripheral blood (PB) CD34+ cell counts, CD34+ cell yield on day1 of collection, total CD34+ cell collection, and total number of apheresis sessions. Mobilization failure was defined as failure to collect ≥2 x106 cells/kg body weight. Mobilization costs were calculated per patient in both groups. Centers for Medicare and Medicaid Services reimbursement rates and Red Book Average Wholesale Price were used for cost determination. Results: At baseline, the LD-CY and P cohorts were well balanced. Compared to LD-CY, P use was associated with higher median peak PB CD34+ cell count (68/µl vs. 36/µl, p=0.048), CD34+ yield on day 1 of collection (6.9 x106/kg vs. 2.4 x106/kg, p=0.001), and total CD34+ cell yield (11.6 x106/kg vs. 7x106/kg, p=0.001). Median numbers of apheresis sessions were 2 in each group (p=0.17). In pts with prior lenalidomide use, mobilization failure rate in the LD-CY group was higher compared to the P group (20% vs. 0%, p=0.01). P group had a higher number of pts collecting ≥10x106/kg CD34+ cells (60.6% vs. 31%, p=0.01). Rate of infectious complications, transfusion requirements and hospitalizations was similar in both groups. The average total cost of mobilization in the P group was significantly higher compared to the LD-CY group ($28,980 vs. $19,627, p-value<0.0001). Conclusions: Our data indicates that although associated with a significantly higher total mobilization cost, plerixafor produced a more robust PBSC mobilization, without any collection failures.
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