How Does Pre-emptive Plerixafor Affect Stem Cell Mobilization for Myeloma Transplant?

The pre-emptive administration of stem cell mobilization agent plerixafor enhanced collection efficiency and resulted in more than $10,000 in cost savings compared with standard administration, according to the results of a recent study published in Leukemia Research.

“The current study suggests that the benefits of using plerixafor as a stem cell mobilization regimen may be further enhanced by a pre-emptive schedule where plerixafor administration is initiated on the evening prior to the first day of stem cell collection, as opposed to the standard schedule, where plerixafor administration is initiated on the evening prior to the second day of stem cell collection only if there is insufficient yield on the first day,” Leslie A. Andritsos, of the University of New Mexico, Albuquerque, and colleagues wrote.

The researchers looked at data from 299 patients who were administered either pre-emptive plerixafor (P-PL; n=241) or standard plerixafor (S-PL; n=58).

Overall, P-PL resulted in significant improvements in stem cell collection compared with S-PL. The median CD34+ cell count in peripheral blood for P-PL was 21 compared with 8 for S-PL (P<.01). Median total CD34+ cell count collected on the first day was 6.75 X 10⁶ for P-PL compared with 1.96 X 10⁶ in patients receiving S-PL (P<.01).

Multivariable analyses showed that P-PL remained significantly associated with ability to collect ≥2 X 10⁶/kg CD34+ on the first day (odds ratio=4.05; 95% CI, 1.19–13.83; P=.03) and ≥5 X 10⁶/kg CD34+ in total (OR=3.09; 95% CI, 1.04–9.23; P=.04).

“Of note, on multivariable analysis, other factors significantly associated with achieving the collection goal in 1 day included complete or partial response at the time of collection (versus stable/progressive disease) and type 2 diabetes (versus no diabetes),” the researchers wrote.

Patients given P-PL needed an average of 1.24 collections to reach the required count of CD34+ cells compared with 2.29 collections for S-PL. Average costs per patients ranged from $13,131 to $13,259 for patients given P-PL to $24,270 to $24,507 for patients given S-PL. The researchers calculated that use of P-PL saved 46% of costs, with savings reaching $11,248 per patient.

“While it is clear that addition of plerixafor can significantly enhance stem cell yields, the cost of the agent largely prevents routine use in patients who are not at risk of mobilization failure,” the researchers noted. “Our stem cell mobilization experience suggests that pre-emptive plerixafor administration in myeloma patients undergoing ASCT may improve clinical and economic outcomes. Pre-emptive plerixafor significantly increased CD34+cell yield and the rate of adequate CD34+cells on Day 1 of collection. It is associated with substantial cost savings compared with the standard strategy.”