A combination of low‐dose cyclophosphamide and colony‐stimulating factors is more cost‐effective than granulocyte‐colony‐stimulating factors alone in mobilizing peripheral blood stem and progenitor cells

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Abstract
BACKGROUND: The use of peripheral blood progenitor cells (PBPCs) instead of autologous bone marrow leads to more rapid engraftment following high‐dose chemotherapy. Mobilization regimens differ with respect to toxicity, efficiency, and cost. STUDY DESIGN AND METHODS: Two cohorts of patients with breast cancer received one of two mobilization regimens: granulocyte‐colony‐stimulating factor (G‐CSF) at 10 micrograms per kg was given subcutaneously for 5 days, with leukapheresis begun on Day 6, or low‐dose cyclophosphamide followed by sequential granulocyte‐macrophage‐CSF (GM‐CSF) at 5 micrograms per kg for 5 days and by G‐CSF at 10 micrograms per kg, with leukapheresis begun on Day 11. Results of CD34+ cell collection, engraftment, and costs of mobilization were determined. RESULTS: The combination chemotherapy and growth factor regimen was more efficient in mobilizing CD34+ cells. Sixty‐six percent of patients reached a target 4 × 10(6) CD34+ cells per kg in a single leukapheresis session with the combination regimen, compared to 14 percent who received G‐CSF alone (p < 0.01). The mean number of leukapheresis sessions required to reach a target of 4 × 10(6) CD34+ cells per kg was 1.3 for the combination regimen and 2.7 for the regimen of G‐CSF alone (p < 0.01). One patient in the chemotherapy and growth factor group developed febrile neutropenia. Engraftment was similar in both cohorts of patients. The cost of mobilization, including all supplies and cryopreservation, was $7381 for the G‐CSF regimen and $5508 for the chemotherapy regimen (p < 0.05). This reduction was attributed to the lower number of leukapheresis and cryopreservation sessions, which outweighed the slight increase in expense for chemotherapy and growth factor in the combination regimen. CONCLUSION: This combination mobilization regimen allowed the predictable and efficient collection of CD34+ cells from the peripheral blood in a limited number of leukapheresis sessions, which reduced the cost of mobilization by approximately 25 percent.

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