Cost saving, patient centered algorithm for progenitor cell mobilization for autologous hematopoietic cell transplantation.
Srinivasa Reddy SanikommuEmily S ReeseJiaxian HeCarlos LeeJing AiCandace M ButlerRyan JacobsBei HuShebli AtrashJigar TrivediManisha BhutaniPeter VoorheesSaad Z UsmaniNilanjan GhoshOmotayo FasanLawrence J DruhanJames SymanowskiEdward A CopelanBelinda R AvalosPublished in: Journal of clinical apheresis (2021)
Administration of plerixafor with granulocyte-colony stimulating factor (G-CSF) mobilizes CD34+ cells much more effectively than G-CSF alone, but cost generally limits plerixafor use to patients at high risk of insufficient CD34+ cell collection based on low peripheral blood (PB) CD34+ counts following 4 days of G-CSF. We analyzed costs associated with administering plerixafor to patients with higher day 4 CD34+ cell counts to decrease apheresis days and explored the use of a fixed split dose of plerixafor instead of weight-based dosing. We analyzed 235 patients with plasma cell disorders or non-Hodgkin's lymphoma who underwent progenitor cell mobilization and autologous hematopoietic cell transplantation (AHCT) between March 2014 and December 2017. Two hundred ten (89%) received G-CSF plus Plerixafor and 25 (11%) received G-CSF alone. Overall, 180 patients (77%) collected in 1 day, 53 (22%) in 2 days and 2 (1%) in 3 days. Based on our data, we present a probabilistic algorithm to identify patients likely to require more than one day of collection using G-CSF alone. CD34+ cell yield, ANC and platelet recovery were not significantly different between fixed and standard dose plerixafor. Plerixafor enabled collection in 1 day and with estimated savings of $5000, compared to patients who did not receive plerixafor and required collection for three days. While collection and processing costs and patient populations vary among institutions, our results suggest re-evaluation of current algorithms.
Keyphrases
- peripheral blood
- cell therapy
- single cell
- end stage renal disease
- chronic kidney disease
- newly diagnosed
- ejection fraction
- prognostic factors
- deep learning
- nk cells
- bone marrow
- heavy metals
- cerebrospinal fluid
- patient reported outcomes
- mesenchymal stem cells
- case report
- risk assessment
- diffuse large b cell lymphoma
- physical activity
- pi k akt
- neural network
- platelet rich plasma
- patient reported
- body weight
- cell cycle arrest