Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT

Bone Marrow Transplant. 2013 Jun;48(6):771-6. doi: 10.1038/bmt.2012.216. Epub 2012 Nov 19.

Abstract

The effectiveness of stem cell mobilization with G-CSF in lymphoma patients is suboptimal. We reviewed our institutional experience using chemomobilization with etoposide (VP-16; 375 mg/m(2) on days +1 and +2) and G-CSF (5 μg/kg twice daily from day +3 through the final day of collection) in 159 patients with lymphoma. This approach resulted in successful mobilization (>2 × 10(6) CD34+ cells collected) in 94% of patients (83% within 4 apheresis sessions). Fifty-seven percent of patients yielded at least 5 × 10(6) cells in 2 days and were defined as good mobilizers. The regimen was safe with a low rate of rehospitalization. Average costs were $14 923 for good mobilizers and $27 044 for poor mobilizers (P<0.05). Using our data, we performed a 'break-even' analysis that demonstrated that adding two doses of Plerixafor to predicted poor mobilizers at the time of first CD34+ cell count would achieve cost neutrality if the frequency of good mobilizers were to increase by 21%, while the frequency of good mobilizers would need to increase by 25% if three doses of Plerixafor were used. We conclude that chemomobilization with etoposide and G-CSF in patients with lymphoma is effective, with future opportunities for cost-neutral improvement using novel agents.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / economics
  • Antineoplastic Agents, Phytogenic* / administration & dosage
  • Antineoplastic Agents, Phytogenic* / economics
  • Autografts
  • Benzylamines
  • Costs and Cost Analysis
  • Cyclams
  • Etoposide* / administration & dosage
  • Etoposide* / economics
  • Female
  • Granulocyte Colony-Stimulating Factor / administration & dosage
  • Granulocyte Colony-Stimulating Factor / economics
  • Hematopoietic Stem Cell Mobilization / economics*
  • Hematopoietic Stem Cell Mobilization / methods
  • Hematopoietic Stem Cell Transplantation / economics*
  • Hematopoietic Stem Cell Transplantation / methods
  • Heterocyclic Compounds / administration & dosage
  • Heterocyclic Compounds / economics
  • Hodgkin Disease* / economics
  • Hodgkin Disease* / therapy
  • Humans
  • Lymphoma, Non-Hodgkin* / economics
  • Lymphoma, Non-Hodgkin* / therapy
  • Male
  • Middle Aged

Substances

  • Anti-HIV Agents
  • Antineoplastic Agents, Phytogenic
  • Benzylamines
  • Cyclams
  • Heterocyclic Compounds
  • Granulocyte Colony-Stimulating Factor
  • Etoposide
  • plerixafor