Yazarlar : Vishnu P, Roy V, Paulsen A, Zubair AC.

Yayın : Transfusion.

Yayın Yılı : 2011

Pubmed Linki : http://www.ncbi.nlm.nih.gov/pubmed/21658047

Konu : Aferez

Literatür İçeriği :  

Abstract

BACKGROUND:

Plerixafor (P) reduces mobilization failure rates but it is very expensive. For better utilization of P, we employed a risk-adaptive strategy of using it only in patients who are at high risk of mobilization failure, defined by peripheral blood (PB) CD34+ cell count of fewer than 10 × 10(6) /L after 4 days of filgrastim (F) alone.

STUDY DESIGN AND METHODS:

Herein, we present the results of efficacy and cost-benefit analysis of this risk-adaptive approach for hematopoietic progenitor cell (HPC) collection. All patients received daily F for 4 days, and P was added for those "at-risk" patients from Day 4 with apheresis commencing the following morning. F and P were continued daily for up to a maximum of 4 days or until more than 5 × 10(6) CD34+ cells/kg were collected. Forty-two transplant-eligible patients underwent HPC mobilization.

RESULTS:

Eighteen patients mobilized with F alone and 24 patients required P with F. Two patients failed adequate HPC mobilization after F+P. Addition of P increased the PB CD34+ count by 6.8-fold with a mean yield of 4.9 × 10(6) CD34+ cells/kg. Decision-analysis model estimated cost-effectiveness for this risk-adaptive approach of using P with savings of $19,300/patient. Engraftment after HPC infusion was similar among the patients regardless of mobilization regimens.

CONCLUSION:

These results suggest that addition of P to F based on a risk-adaptive strategy significantly reduces the frequency of mobilization failures and is also cost-effective.

Literatür Arşivi