Development and validation of a decision-making algorithm to guide the use of plerixafor for autologous hematopoietic stem cell mobilization

Bone Marrow Transplant. 2011 Jan;46(1):64-9. doi: 10.1038/bmt.2010.78. Epub 2010 Apr 12.

Abstract

Plerixafor is an inhibitor of CXCR-4 (CXC chemokine receptor-4)/SDF (stromal cell-derived factor)-1 binding used in combination with granulocyte colony-stimulating factor (G-CSF) for mobilization of autologous peripheral blood hematopoietic stem cells (HSCs). We developed a data-generated, cost-saving decision-making algorithm that uses the CD34+ count in the peripheral blood on the fourth day of G-CSF administration (PB-CD34+), and the collection target (T-CD34+) to decide between continuing G-CSF only (G approach) or adding plerixafor to the mobilization regimen (G+P approach) aiming at the lowest cost. The G+P approach was more cost-effective with lower PB-CD34+. It was possible to determine, for each T-CD34+, the maximum PB-CD34+ for which the G+P approach is cost-effective, generating an algorithm for the use of plerixafor. We validated this algorithm in a cohort of 34 patients undergoing HSC mobilization. In all, 11 patients completed collection on the G approach and 23 patients on the G+P approach, with 91% of the patients completing collection within the predicted number of apheresis sessions. All patients who underwent transplantation engrafted with minimal differences in engraftment time between G and G+P approaches. This validated algorithm provides a potential cost-saving decision tool for the use of plerixafor in autologous HSC mobilization.

Publication types

  • Validation Study

MeSH terms

  • Algorithms
  • Antigens, CD34 / blood
  • Benzylamines
  • Blood Cell Count
  • Blood Component Removal / statistics & numerical data
  • Cohort Studies
  • Cost Savings / methods*
  • Cyclams
  • Decision Support Techniques*
  • Drug Therapy, Combination / economics
  • Female
  • Graft Survival / drug effects
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Hematopoietic Stem Cell Mobilization / economics
  • Hematopoietic Stem Cell Mobilization / methods*
  • Heterocyclic Compounds / economics
  • Heterocyclic Compounds / therapeutic use*
  • Humans
  • Lymphoma / blood
  • Lymphoma / therapy
  • Male
  • Middle Aged
  • Multiple Myeloma / blood
  • Multiple Myeloma / therapy
  • Peripheral Blood Stem Cell Transplantation*
  • Transplantation, Autologous

Substances

  • Antigens, CD34
  • Benzylamines
  • Cyclams
  • Heterocyclic Compounds
  • Granulocyte Colony-Stimulating Factor
  • plerixafor