Economic evaluation of plerixafor addition in the mobilization and leukapheresis of hematopoietic stem cells for autologous transplantation: a systematic review

ABSTRACT

Introduction

Although plerixafor in association with granulocyte colony-stimulating factor (G-CSF) can improve mobilization and collection of hematopoietic stem cells (HSC) by leukapheresis, cost may limit its clinical application. The present study systematically reviews economic evaluations of plerixafor plus G-CSF usage compared to G-CSF alone and compares different strategies of plerixafor utilization in multiple myeloma and lymphoma patients eligible for autologous HSC transplantation.

Areas covered

Relevant economic evaluations, partial or complete, were searched on PubMed, Embase, LILACS, and Cochrane Central Register of Controlled Trials for a period ending 30 June 2021. This systematic review was reported following the PRISMA Statement. Six economic evaluations were included, considering the use of upfront or just-in-time plerixafor compared to G-CSF alone or other plerixafor strategies. Most comparisons showed both increased cost and health benefits with the addition of plerixafor. Most analyses favored just-in-time plerixafor compared to upfront plerixafor, with a probable preference for broader cutoffs for just-in-time plerixafor initiation.

Expert opinion

Plerixafor is a potentially cost-effective technology in the mobilization of HSC in patients with multiple myeloma and lymphomas eligible for autologous HSC transplantation. There is a decreased number of leukapheresis sessions and remobilizations and a higher yield of CD34+ cells.

KEYWORDS:

• cost analysis
• granulocyte colony-stimulating factor
• hematopoietic stem cell mobilization
• plerixafor
• stem cell transplantation

Article highlights

• Given in combination with G-CSF, plerixafor increases HSC mobilization in peripheral blood for collection and subsequent autologous transplantation in multiple myeloma and lymphoma patients. There is an elevated HSC collection, over a shorter time interval with no increase in adverse events.

• Despite its potential clinical advantages, the cost associated with plerixafor places limits on its utilization.

• Plerixafor addition decreases the number of leukaphereses and remobilizations and results in a higher yield of CD34+ cells to 10⁶/kg.

• Evidence for the cost-effectiveness of plerixafor is available only from high-income countries.

• Additional economic evaluation studies are needed to estimate the cost-effectiveness of plerixafor-utilization protocols in different regions of the world. Optimal parameters of plerixafor addition in resource-limited settings and its long-term impact on health outcomes remain to be determined.

Acknowledgments

The final version of the manuscript was edited for English language usage by Prof. Steven Witkin of Weill Cornell Medicine with funding by the authors.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All study authors meet the criteria for authorship as outlined by the journal policy and agree for the final version of the manuscript to be published.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2140140

Additional information

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.