Authors' objectives: The objectives of this report are to evaluate the effectiveness, safety and cost impact of using plerixafor as a stem cell mobilizer in multiple myeloma or non-Hodgkin's lymphoma patients requiring autologous stem cell transplants. We evaluated two regimens using plerixafor: (1) a regimen where plerixafor is used as first-line initialization i.e. upfront use of plerixafor; and (2) a regimen where plerixafor is used as immediate rescue treatment due to ineffective stem cell mobilization during the mobilization process with other agents i.e. pre-emptive use of plerixafor (also known as on demand or just-in-time use of plerixafor). The comparator regimens of interest used G-CSF alone or cyclophosphamide plus G-CSF.

Authors' recommendations: • Plerixafor is a novel mobilization agent that has considerable advantages over the alternatives. It is more effective than either G-CSF alone or cyclophosphamide plus G-CSF in mobilizing sufficient stem cells for transplantation, and it is not associated with the severe complications and unpredictability of cyclophosphamide mobilization. • The main disadvantage of plerixafor is its high cost. Published studies and an evaluation of our local MUHC experience have found upfront plerixafor regimens to be more expensive than other mobilization regimens, mainly due to the high cost of the drug. • In order to mitigate these high costs, some institutions have developed risk-adapted algorithms for the use of plerixafor only in those patients at risk of poor mobilization. Studies that evaluated such pre-emptive plerixafor regimens versus G-CSF only or cyclophosphamide plus G-CSF have reported good mobilization rates. • Furthermore, our analysis of local data found that projected costs associated with pre-emptive plerixafor regimens using either G-CSF alone, or cyclophosphamide plus G-CSF, were considerably lower than that of an upfront plerixafor mobilization regimen, making the adoption of such regimens a more attractive option at the MUHC.

Project Status: Completed

Year Published: 2017

URL for published report: https://muhc.ca/sites/default/files/micro/m-TAU/muhc_tau_2017_plerixafor_a_0.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5

Contact Name: nandini.dendukuri@mcgill.ca

Contact Email: nandini.dendukuri@mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)