Abstract
Mobilization and collection of peripheral blood stem cells is part of the standard treatment procedure for non-Hodgkin’s lymphoma patients eligible for high-dose chemotherapy with autologous stem cell transplantation. Mobilization is usually achieved with chemotherapy and/or cytokines, but plerixafor might be added in case of poor mobilization. Due to the high cost several institutions have developed their own management pathway to optimize use of plerixafor. Such models are however rarely generalizable; in a multi-center, European, non-interventional study, evaluating the impact of plerixafor in poor mobilizers, country specific differences in patient treatment and cost structure were obvious. For German centers, there was a non-significant reduction in the number of apheresis sessions carried out and in apheresis costs. In contrast to other European countries the majority of German Plerixafor patients were very poor mobilizing patients with initial CD34+ cell count ≤ 10/µl (40/51). In this group the number of apheresis sessions decreased from 2.1 to 1.6 sessions per patient (p = 0.01) and costs decreased from €6246 to €4758 (p = 0.01). Our results show that preemptive plerixafor use has a strong effect in poor mobilizers with an initial CD34+ cell count ≤ 10 cells/µl.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.University Hospital of Cologne, Cologne, Germany 6 Department of Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany 7 RJM Group, LLC, 13028 Smoketown Road, Woodbridge, VA22192, USA 8 Department of Haematology, Saint-Antoine Hospital, Paris, FranceHigh-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has become the standard of care for patients with relapsed and/or high-risk non-Hodgkin’s lymphoma (NHL) ever since clinical trials have shown a benefit over standard chemotherapy in terms of progressionfree and overall survival [1,2,3,4]
Patients treated during the plerixafor showed a trend towards fewer apheresis sessions, lower total apheresis blood volume and less time spent on apheresis
Plerixafor, a CXCR4 inhibitor increases the amount of circulating stem cells several folds when given in combination with conventional mobilization regimens
Summary
University Hospital of Cologne, Cologne, Germany 6 Department of Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany 7 RJM Group, LLC, 13028 Smoketown Road, Woodbridge, VA. 22192, USA 8 Department of Haematology, Saint-Antoine Hospital, Paris, France. High-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has become the standard of care for patients with relapsed and/or high-risk non-Hodgkin’s lymphoma (NHL) ever since clinical trials have shown a benefit over standard chemotherapy in terms of progressionfree and overall survival [1,2,3,4]. 10–25% of NHL patients fail to achieve sufficient stem cell yields to proceed to transplantation with current mobilization regimens. These patients either undergo further mobilization attempts or receive alternative treatment options, requiring additional health care resources. Mobilization failure impacts treatment outcome; in a retrospective study it was found that the three-year survival rate was 33% in poor mobilizers (CD34+ < 2 × 106 cells/kg) as compared to 71% in patients mobilizing adequately [5]
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