A new study of patients with multiple myeloma and lymphoma who require bone marrow stem cell transplants suggests that treatment with a particular drug combination can help reduce or eliminate the need for weekend stem cell collection and unscheduled hospital admissions -- two factors that can significantly increase treatment costs.

Plerixafor plus G-CSF may be the right combination for some patients, according to Paul Shaughnessy, MD, Clinical Director of the Texas Transplant Institute and lead investigator of an unpublished study, presented at the American Society for Blood and Marrow Transplantation meeting held in Orlando last week.

"People with multiple myeloma and relapsed lymphomas can be given long-term remission and increased survival if we can do high-dose chemotherapy on them," Dr. Shaughnessy explained. "The problem is we have to protect their own bone marrow from the high dose chemotherapy. So before we give the high dose chemotherapy, we will collect their own autologous bone marrow stem cells out of their blood stream. That is a very established treatment that we know benefits these patients."
But if doctors can't get patient's own autologous stem cells, it puts them at a disadvantage because a life prolonging treatment is taken away.

"What we have found is traditional ways of using a drug called G-CSF alone or after chemotherapy can work in most but not all people. When we use a combination of G-CSF and plerixafor -- this new drug that was FDA approved last year-we get much better stem cell mobilization. We are able to get the stem cells in patients we couldn't get stem cells on before and up front we may be collecting the stem cells quicker and being able to go to transplant more easily."

The study also shows that treatment can help hospitals to more accurately predict the number of days necessary to collect bone marrow stem cells for autologous transplantation. The study compares efficacy, costs, logistical issues and clinical outcomes of CD34 + cell mobilization between plerixafor + G-CSF and the other approach: chemotherapy + G-CSF. Based on these findings, hospitals may be able to reduce operating costs associated with the management of the drug inventory, length of stay for patients and reduced need for weekend or unscheduled treatment.

The way it works is that when patients are ready to get their stem cells collected, they receive the G-CSF for four days in a row as an outpatient daily shot. The next morning, they come back for stem cell collection.

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