Van de Wyngaert Zoé, Nerich Virginie, Fouquet Guillemette, Chrétien Marie-Lorraine, Caillot Denis, Azar Nabih, Garderet Laurent, Lenain Pascal, Macro Margaret, Bourhis Jean-Henri, Belhocine Ramdane, Jaccard Arnaud, Karlin Lionel, Bobin Arthur, Moya Niels, Systchenko Thomas, Gruchet Cecile, Giraud Christine, Guidez Stéphanie, Darras Claire, Princet Isabelle, Touzeau Cyrille, Moreau Philippe, Hulin Cyrille, Deconinck Erik, Limat Samuel, Leleu Xavier
CHU Lille, Service des Maladies du Sang, F-59000, Lille, France.
Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France.
Bone Marrow Transplant. 2020 Dec;55(12):2254-2260. doi: 10.1038/s41409-020-0940-3. Epub 2020 May 23.
Mobilization of peripheral blood stem cells (PBSC) can be performed using plerixafor, which is expensive, or high-dose cyclophosphamide (HDCy). We hypothesized that the overall cost of mobilization with plerixafor might not be greater if the cost of complication management was considered. We performed a cost analysis of these two strategies. This multicentric observational study recruited patients with myeloma who underwent a first PBSC mobilization. We considered direct medical costs, including hospitalization, mobilization agents, apheresis, and supportive treatments. We included 111 patients, 54 and 57 in the HDCy and plerixafor groups, respectively. Cost of mobilization with HDCy was 5097 ± 2982€ vs. 10958 ± 1789€ for plerixafor (p < 0.0001). Cost of agents used was 1287 ± 779€ vs. 6552 ± 509€, respectively (p = 0.0009). The mean number of days of hospitalization was 2 and 2.1 days, respectively (p = 0.035). All patients achieved the minimum PBSC collection target (p = 1.0); however, ASCT was performed with HDCy in 67% patients and with plerixafor in 86% (p = 0.02). Plerixafor mobilization incurred a greater cost, mostly due to the greater cost of the drug. Hospitalization length in the two groups was similar in our series. Interestingly, plerixafor appeared to be a very effective and safe mobilizing approach translating into a greater ASCT success.
外周血干细胞（PBSC）动员可使用普乐沙福（价格昂贵）或大剂量环磷酰胺（HDCy）来进行。我们推测，如果考虑并发症管理成本，使用普乐沙福进行动员的总体成本可能不会更高。我们对这两种策略进行了成本分析。这项多中心观察性研究纳入了首次进行PBSC动员的骨髓瘤患者。我们考虑了直接医疗成本，包括住院、动员剂、血细胞分离术和支持性治疗。我们纳入了111例患者，HDCy组和普乐沙福组分别为54例和57例。HDCy动员的成本为5097±2982欧元，而普乐沙福为10958±1789欧元（p<0.0001）。所用药物的成本分别为1287±779欧元和6552±509欧元（p=0.0009）。平均住院天数分别为2天和2.1天（p=0.035）。所有患者均达到了最低PBSC采集目标（p=1.0）；然而，67%接受HDCy的患者和86%接受普乐沙福的患者进行了自体造血干细胞移植（ASCT）（p=0.02）。普乐沙福动员的成本更高，主要是由于药物成本更高。在我们的系列研究中，两组的住院时间相似。有趣的是，普乐沙福似乎是一种非常有效且安全的动员方法，这转化为更高的ASCT成功率。
