TY - JOUR TI - Utilization and cost implications of hematopoietic progenitor cells stored for a future salvage autologous transplantation or stem cell boost in myeloma patients AU - Chhabra, Saurabh AU - Thapa, Bicky AU - Szabo, Aniko AU - Konings, Steve AU - D'Souza, Anita AU - Dhakal, Binod AU - Jerkins, James H. AU - Pasquini, Marcelo C. AU - Johnson, Bryon D. AU - Hari, Parameswaran N. AU - Hamadani, Mehdi T2 - Biology of Blood and Marrow Transplantation AB -

Abstract

Autologous hematopoietic cell transplantation (autoHCT) is a standard initial treatment for myeloma. Consensus guidelines recommend collecting sufficient hematopoietic progenitor cells (HPC) for two transplants in all eligible patients. It is common practice across transplant programs to collect enough HPC for two transplants in myeloma patients despite lack of published data on utilization of HPC stored for future use. In this single-center retrospective study, we analyzed the utilization of HPC collected and stored at the time of first autoHCT in patients with myeloma and the cost implications of HPC collection targets sufficient for two transplants. In a cohort of 400 patients (median age 63 years; range, 22-79), after a median follow-up of 50.4 months, 197 patients had relapsed and 36 received HPC infusion as salvage autoHCT (n=29) and/or HPC boost (n=8). In this cohort, a median of 4.3 × 106/kg (range, 1.1-12.9) CD34+ cell dose was used in first autoHCT and a median of 4.4 × 106/kg (range, 1.0-20.2) CD34+ cells were stored for future use. At 6 years from the first autoHCT, the cumulative incidence of salvage autoHCT without and with HPC boost was estimated to be 12.0% and 13.9%, respectively. The HPC utilization was significantly higher in 60-64 years age group, while none who were ≥70 years at the time of first autoHCT received a salvage autoHCT. Using CD34+ cell dose infused during the first autoHCT as cut-off for individual patient, the estimated mean additional cost of HPC collection intended for subsequent use (over and above HPC used for first autoHCT) was $10,795 ($4.32 million for the cohort), an estimated 14% of which (i.e., $583,600) was actually used up in salvage autoHCT by 6 years from first autoHCT. In conclusion, our results suggest the need for re-appraisal of HPC collection targets for salvage autoHCT and argue against HPC collection and storage for salvage autoHCT in patients ≥70 years at the time of first autoHCT.

DA - 2020/07/23/ PY - 2020 DO - 10.1016/j.bbmt.2020.07.019 DP - www.bbmt.org VL - 0 IS - 0 J2 - Biology of Blood and Marrow Transplantation LA - English SN - 1083-8791, 1523-6536 UR - https://www.bbmt.org/article/S1083-8791(20)30450-X/abstract Y2 - 2020/07/28/17:49:57 ER -