Assessment of Mobilization Cost for Multiple Myeloma Using 2 Different Mobilization Strategies: High-Dose Cyclophosphamide Versus Plerixafor. on Behalf of IFM
Authors: van de Wyngaert Zoe , Azar Nabih , Lenain Pascal , Macro Margaret , Bourhis Jean-Henri , Garderet Laurent , Jaccard Arnaud , Karlin Lionel , Giraud Christine , Guidez Stéphanie , Hebraud Benjamin , Roussel Muriel , Marit Gerald , Hulin Cyrille , Deconinck Eric , Attal Michel , Moreau Philippe , Caillot Denis , Limat Samuel , Leleu Xavier , Chretien Marie-Lorraine 
Published: October 2019

Abstract
Background.
Peripheral blood stem cell (PBSC) collection prior to high dose chemotherapy for autologous transplantation (ASCT) is a standard of care, and an attractive alternative to the use of bone marrow cells, for transplantation in Multiple Myeloma (MM). The optimal methodology for mobilizing PBSC has yet to be defined, both G-CSF and GM-CSF can be used; although, the stimulatory effect may be more pronounced when given after high dose cyclophosphamide (usually administered at a dose of 1.5 to 6g/m2 IV for one to two days) and use of Plerixafor, a CXCR4 antagonist (Mozobil®). The latter 2 options are preferred, overall, in France. Indeed, it was shown that the most recent combined bortezomib and IMids-based induction regimens used prior to ASCT in MM upfront yielded poorly or required multiple days of collection with steady state method.
Because of the intense competition for hospital resources and the staff required to evaluate and manage patients preparing for stem cell mobilization and transplantation, it is reasonable to attempt to quantify the total impact of stem cell mobilization on available staff resources and cost to the hospital, especially when newer therapies, i.e. plerixafor is available and may be more suitable for some of these patients.
We aimed at better evaluate the burden of stem cell mobilization on the hospital of the 2 techniques of mobilization, either high dose endoxan (n=57) versus plerixafor (n=55); this study will not, however, evaluate the suitability or advisability of one therapy versus another.
Method and Results .
This is a retrospective observational cohort database analysis of 112 consecutive patients with MM treated upfront with ASCT between 2009 and 2013 and that had been mobilized with either high dose endoxan or plerixafor from 15 IFM centers.
We planned to determine the cost versus benefit of either technique taking in consideration a number of key markers that influence the mobilization process. A cost-consequences analysis of the different regimens of mobilization will be performed. Cost will be quantified using "microcosting" approach. Only direct medical costs are included in this economic analysis. Hospital resources will be calculated using two different approaches: per diem hospitalization costs (excluding direct medical costs) versus French public diagnosis-related group (DRG). The point of view of the French Public Health System is adopted for this study. Monetary values for 2012 euros prices will be used for all components.
Median (range) age was 59.5 (24-72), sex ratio was 1.5, ISS 3 was 26% in either group, all patients were collected to allow the number of graft requested by the hematologist of reference. The median CD34 collected was 8.9 (4-30) for HD cyclophosphamide and 5.8 (2-15) for plerixafor. All data will be updated at ASH 2016 including cost comparison.
Conclusion.
Because of the intense competition for hospital resources and the staff required to evaluate and manage patients preparing for stem cell mobilization and transplantation, it is reasonable to attempt to quantify the total impact of stem cell mobilization on available staff resources and cost to the hospital, especially when newer therapies, i.e. plerixafor is available and may be more suitable for some of these patients.

Disclosures
Macro: Janssen: Consultancy, Honoraria; Bristol: Consultancy; Celgen: Consultancy, Honoraria; Novartis: Honoraria; sanofi: Consultancy; Amgen: Consultancy, Honoraria. Hulin:celgene: Honoraria; janssen: Honoraria; takeda: Honoraria. Attal:sanofi: Consultancy; celgene: Consultancy, Research Funding; janssen: Consultancy, Research Funding; amgen: Consultancy, Research Funding. Moreau:Novartis: Honoraria; Bristol-Myers Squibb: Honoraria; Takeda: Honoraria; Amgen: Honoraria; Janssen: Honoraria, Speakers Bureau; Celgene: Honoraria. Leleu:TEVA: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria; LeoPharma: Honoraria; Pierre Fabre: Honoraria; Amgen: Honoraria; Bristol-Myers Squibb: Honoraria; Takeda: Honoraria; Celgene: Honoraria; Janssen: Honoraria.