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

摘要

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 x 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 Dollars 10,605 (Dollars 9,230-Dollars 14,540). Ideal outcomes were associated with lower costs compared with non-ideal outcomes (median (IQR), Dollars 9914 (Dollars 8,743-Dollars 11,168) versus Dollars 11232 (Dollars 9,292-Dollars 15,518) respectively, P<0.001). The median (IQR) cost of non-ideal outcome was higher among lymphoma patients (Dollars 12,293 (Dollars 9578-Dollars 16,268)) compared with myeloma patients (Dollars 10,388 (Dollars 9,355-Dollars 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.