RESUMEN
Certain patients who receive granulocyte colony-stimulating factor (GCSF) for autologous hematopoietic stem cell (AHSC) collection fail to mobilize well enough to proceed with transplant. When plerixafor is used with GCSF, the likelihood of achieving the CD34⺠stem cell target in fewer collections is higher; plerixafor use in all patients is unlikely to be cost-effective. This study retrospectively evaluated the effectiveness of utilizing a peripheral blood CD34⺠stem cell count (PBCD34) ≤8/µL on day 4 of GCSF-based AHSC mobilization as a threshold for plerixafor administration, and compared the efficacy of collection and cost analysis using historical controls. All patients in the study cohort reached their CD34⺠targets in ≤3 collections. Significantly more patients who received plerixafor + GCSF versus GCSF alone reached their CD34⺠target in one collection (P = 0.045); however, there were no significant differences in the number of collections or in cumulative product yields. The historical cohort had 10.3% mobilization failures; the number of collections per patient needed to reach the target was significantly higher in the historical cohort versus study cohort (P = 0.001) as was the number of patients requiring more than one collection to reach their target (P = 0.023). However, the average cost per patient was also significantly higher in the study cohort (P = 0.025). Further refinement of the algorithm may reduce the difference in cost between the two mobilization strategies.
Asunto(s)
Algoritmos , Antígenos CD34/análisis , Movilización de Célula Madre Hematopoyética , Compuestos Heterocíclicos/uso terapéutico , Receptores CXCR4/antagonistas & inhibidores , Adolescente , Adulto , Anciano , Bencilaminas , Recuento de Células , Análisis Costo-Beneficio , Costos y Análisis de Costo , Ciclamas , Femenino , Movilización de Célula Madre Hematopoyética/economía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante AutólogoAsunto(s)
Infección Hospitalaria/microbiología , Daptomicina/farmacología , Farmacorresistencia Bacteriana Múltiple , Enterococcus faecium/efectos de los fármacos , Infecciones por Bacterias Grampositivas/microbiología , Neoplasias Hematológicas/complicaciones , Trasplante de Células Madre Hematopoyéticas , Infecciones Oportunistas/microbiología , Complicaciones Posoperatorias/microbiología , Antibacterianos/uso terapéutico , Bacteriemia/epidemiología , Bacteriemia/etiología , Bacteriemia/microbiología , Colitis/epidemiología , Colitis/etiología , Colitis/microbiología , Infección Hospitalaria/complicaciones , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Enterococcus faecium/aislamiento & purificación , Enfermedad Injerto contra Huésped/complicaciones , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Humanos , Huésped Inmunocomprometido , Iowa/epidemiología , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/epidemiología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Vancomicina/farmacología , Vancomicina/uso terapéutico , Resistencia a la VancomicinaRESUMEN
This study evaluates the predictive value of post-therapy 18-fluoro-deoxyglucose positron emission tomography (FDG-PET), including indeterminate studies, following curative-intent therapy in diffuse large B-cell lymphoma (DLBCL). Consecutive patients from September 2002 to December 2005 were prospectively offered enrollment in an observational registry. Available FDG-PET reports after primary therapy were interpreted by hematologist-oncologists as positive, negative, or indeterminate. One hundred twenty-five patients with DLBCL had a median follow-up of 35.2 months. Ninety-three percent were treated with R-CHOP-like therapy. Twenty percent of PET reports were judged indeterminate. Event-free survival (EFS) at 3 years for the negative and indeterminate groups was 85% and 71%, respectively (p = 0.28 by log-rank). Overall survival (OS) at 3 years for negative, indeterminate, and positive groups was 89%, 88%, and 48%. Combining the pre-therapy International Prognostic Index (IPI) with the post-therapy FDG-PET result added to the predictive value of the study for patients. Three-year EFS for patients with low or low-intermediate IPI risk and an indeterminate FDG-PET report was 93%, while for those with high or high-intermediate pre-therapy IPI the 3-year EFS was 45% (p < 0.02). Interpreting FDG-PET reports following curative-intent chemotherapy in patients is informative but imprecise, and incorporation of pre-therapy prognosis can improve predictive utility.