Outcome, toxicity profile and cost analysis of autologous stem cell mobilization

Bone Marrow Transplant. 2011 Aug;46(8):1084-8. doi: 10.1038/bmt.2010.254. Epub 2010 Nov 1.

Abstract

Autologous stem cell mobilization (ASCM) is conventionally done using high-dose CY plus granulocyte colony-stimulating factor (G). It is important to examine the outcomes, toxicity profile and costs of ASCM associated with CY+G. A retrospective study was conducted in 236 patients with myeloma or lymphoma undergoing ASCM with CY+G. An ideal outcome was defined as 2 × 10(6) CD34+ cells/kg collected on the planned day of collection in 1 or 2 apheresis without a negative clinical event. The total cost of ASCM including clinical events, were reported based on Medicare part-B physician, laboratory and ancillary fee schedule. ASCM was successful in 213 (90%) patients, but an ideal outcome was seen in only 50 (20%) patients. Median (interquartile range, IQR) total cost of CY+G stem cells mobilization was $10,605 ($9,230-$14,540). Ideal outcomes were associated with lower costs compared with non-ideal outcomes (median (IQR), $9914 ($8,743-$11,168) versus $11232 ($9,292-$15,518) respectively, P<0.001). The median (IQR) cost of non-ideal outcome was higher among lymphoma patients ($12,293 ($9578-$16,268)) compared with myeloma patients ($10,388 ($9,355-$14,360) (P=0.04). Although mobilization success is eventually realized with CY+G, it has a low rate of ideal outcome, associated with significant adverse events and costs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cyclophosphamide / administration & dosage
  • Cyclophosphamide / economics
  • Female
  • Granulocyte Colony-Stimulating Factor / administration & dosage
  • Granulocyte Colony-Stimulating Factor / economics
  • Hematopoietic Stem Cell Mobilization / adverse effects*
  • Hematopoietic Stem Cell Mobilization / economics*
  • Hematopoietic Stem Cell Mobilization / methods
  • Humans
  • Lymphoma / economics
  • Lymphoma / surgery
  • Male
  • Middle Aged
  • Multiple Myeloma / economics
  • Multiple Myeloma / surgery
  • Retrospective Studies
  • Stem Cell Transplantation / adverse effects
  • Stem Cell Transplantation / economics
  • Stem Cell Transplantation / methods
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Granulocyte Colony-Stimulating Factor
  • Cyclophosphamide