Contributions
Type: Publication Only
Background
There are different strategies to mobilize peripheral blood CD34+ cells in oncohematologic patients that will receive an autologous stem cell transplantation (ASCT). As mobilizers drugs (G-CSF), in addition to the original filgrastim (Neupogen®) and lenograstim (Granocyte®), since 2012 we have a biosimilar filgrastim (Nivestim®).
Aims
Our objective was to compare the effectiveness and cost of these drugs in our hospital during the past six years.
Methods
We retrospectively analyzed patients undergoing peripheral blood CD34+ apheresis between January 2009 and December 2014. The collected data included: age, sex, disease (acute leukemia, plasma cell neoplasm, NHL, Hodgkin lymphoma and solid tumor), number of lines of prior chemotherapy, prior use of purine analogs or alkylating agents or radiotherapy, type of mobilization (G-CSF alone, associated with cyclophosphamide or mega-CHOP, or associated with disease-specific chemotherapy) days of administration and daily dose of G-CSF. As for the apheresis procedure: leukocytes, hematocrit, platelets, percentage of mononucleated cells, percentage of CD34+ cells and CD34+ cells/μL in blood just before apheresis; total number of volemias and processed volume, total number of apheresis per mobilization, process time and obtained CD34+ cells (x106/Kg, target > 2), and cost per total mobilization procedure. If ASCT was done, we also collected infused CD34+ cells, day to achieve a neutrophil count > 500/μL and platelets > 20,000/μL. For statistical analysis, SPSS was used.
Results
We studied 201 patients, mean age 50 years (range 2-71) and 64% males, and we used filgrastim in 85 cases, biosimilar 66 and lenograstim 50. There were no significant differences among the three groups for any of the analyzed variables, except for the total number of apheresis per mobilization (the lowest with biosimilar, 1.7, and the highest with filgrastim, 2.1; p=0.009), the number of lines of prior chemotherapy (biosimilar 1.4, lenograstim 1.5 and filgrastim 1.9; p=0.006) and the cost in euros per total mobilization procedure (biosimilar 200, lenograstim 531, and filgrastim 602; p<0.001). Average CD34+ cells in the final product was 6.7 x 106/Kg (range 0.2 to 40.2) for mobilization and similar with all three drugs (p=0.38). In 25 cases (12%), CD34+ <2 x 106/Kg were obtained. ASCT was performed in 103 patients (51%) and no differences in infused CD34+ cells, days to achieve neutrophils > 500/μL or platelets > 20,000/μL (for the two last, average 11 and 17, respectively), were observed.
Summary
In our experience we found no differences between the three analyzed drugs in terms of number of CD34+ cells obtained at the final product of apheresis, or hematopoietic recovery after ASCT. However, for the biosimilar drug fewer apheresis for mobilization procedure were needed, and a significantly lower overall cost was observed.
Keyword(s): Autologous stem cell collection, CD34+ cells, Filgrastim, Mobilization
Session topic: Publication Only
Type: Publication Only
Background
There are different strategies to mobilize peripheral blood CD34+ cells in oncohematologic patients that will receive an autologous stem cell transplantation (ASCT). As mobilizers drugs (G-CSF), in addition to the original filgrastim (Neupogen®) and lenograstim (Granocyte®), since 2012 we have a biosimilar filgrastim (Nivestim®).
Aims
Our objective was to compare the effectiveness and cost of these drugs in our hospital during the past six years.
Methods
We retrospectively analyzed patients undergoing peripheral blood CD34+ apheresis between January 2009 and December 2014. The collected data included: age, sex, disease (acute leukemia, plasma cell neoplasm, NHL, Hodgkin lymphoma and solid tumor), number of lines of prior chemotherapy, prior use of purine analogs or alkylating agents or radiotherapy, type of mobilization (G-CSF alone, associated with cyclophosphamide or mega-CHOP, or associated with disease-specific chemotherapy) days of administration and daily dose of G-CSF. As for the apheresis procedure: leukocytes, hematocrit, platelets, percentage of mononucleated cells, percentage of CD34+ cells and CD34+ cells/μL in blood just before apheresis; total number of volemias and processed volume, total number of apheresis per mobilization, process time and obtained CD34+ cells (x106/Kg, target > 2), and cost per total mobilization procedure. If ASCT was done, we also collected infused CD34+ cells, day to achieve a neutrophil count > 500/μL and platelets > 20,000/μL. For statistical analysis, SPSS was used.
Results
We studied 201 patients, mean age 50 years (range 2-71) and 64% males, and we used filgrastim in 85 cases, biosimilar 66 and lenograstim 50. There were no significant differences among the three groups for any of the analyzed variables, except for the total number of apheresis per mobilization (the lowest with biosimilar, 1.7, and the highest with filgrastim, 2.1; p=0.009), the number of lines of prior chemotherapy (biosimilar 1.4, lenograstim 1.5 and filgrastim 1.9; p=0.006) and the cost in euros per total mobilization procedure (biosimilar 200, lenograstim 531, and filgrastim 602; p<0.001). Average CD34+ cells in the final product was 6.7 x 106/Kg (range 0.2 to 40.2) for mobilization and similar with all three drugs (p=0.38). In 25 cases (12%), CD34+ <2 x 106/Kg were obtained. ASCT was performed in 103 patients (51%) and no differences in infused CD34+ cells, days to achieve neutrophils > 500/μL or platelets > 20,000/μL (for the two last, average 11 and 17, respectively), were observed.
Summary
In our experience we found no differences between the three analyzed drugs in terms of number of CD34+ cells obtained at the final product of apheresis, or hematopoietic recovery after ASCT. However, for the biosimilar drug fewer apheresis for mobilization procedure were needed, and a significantly lower overall cost was observed.
Keyword(s): Autologous stem cell collection, CD34+ cells, Filgrastim, Mobilization
Session topic: Publication Only