The Effectiveness and Cost Effectiveness of Plerixafor + GCSF Versus GCSF ± Chemotherapy as Salvage Mobilization Regimens in Lymphoma and Multiple Myeloma Patients

Abstract

Plerixafor is a novel agent that enhances the mobilization of peripheral blood stem cells (PBSCs) in lymphoma and multiple myeloma (MM) patients whose cells mobilize poorly. Due to the substantial cost associated with its use, we aimed to compare the effectiveness and cost effectiveness of Plerixafor + GCSF (PG) versus GCSF ± Chemotherapy (GC) as salvage mobilization regimens at a stem cell transplant program in Jordan. The charts of consecutive heavily pretreated lymphoma and MM patients who had undergone at least one previous attempt of PBSCs mobilization that failed or resulted in an insufficient cell dose for transplant between 2007 and 2010 were retrospectively reviewed. Patients identified received salvage mobilization with GC (prior to 2009) or PG after Plerixafor's FDA-approval. Data collected included demographics, medical histories, apheresis yields and transplant outcome. Costs were calculated based on the Jordanian Ministry of Health list prices and included the costs of medications, apheresis, hospital stay, and adverse effects management. Average cost effectiveness ratio (ACER) was calculated by dividing the average cost of PBSCs mobilization by the reported mobilization success rate. Seventeen patients were included, five received GC and twelve received PG. A minimum CD34+ cell dose of ≥ 2 x 106 cells/kg was collected from 8 patients (67%) in the PG group compared to 3 (60%) in the GC group. All patients successfully mobilized with PG underwent autologous transplant compared to 2 (67%) mobilized with GC. There was no difference in median days to neutrophil or platelet engraftment between the two groups. PG was associated with an average cost of $25,700 and ACER of $38,358/successful mobilization compared to an average cost of $8,570 and ACER of $14,283/successful mobilization for the GC group. (Table1) Plerixafor as salvage treatment in this group of patients showed an improved success rate of PBSCs mobilization and subsequent transplant but with a significant increase in cost. Prospective comparative effectiveness and cost utility studies are warranted to inform the optimal salvage mobilization regimen. To our knowledge, this is the first study from the Middle East describing the use of Plerixafor and the first with cost effectiveness data outside the US.Table 1Patient characteristics, mobilization outcome and cost analysisSalvage mobilization regimenGCSF ± Chemotherapy (GC)Plerixafor + GCSF (PG)No. of patients512Average age (SD)59 (3.7)46 (12.4)Median CD34+ collected (106 cells/kg)2.13.9Patients Collected ≥ 2 x 106 cells/kg CD34+3 (60%)8 (67%)Average mobilization cost$8,570$25,700Average cost effectiveness ratio (ACER)$14,283/successful mobilization$38,358/successful mobilization Open table in a new tab