Can New Protocols Reduce Costs of Multiple Myeloma Treatment?


Daniel Cancilla, MD, discusses a study performed at the Cleveland Clinic where a new protocol for plerixafor usage for stem cell transplantation was implemented with the goal of cost savings.

Plerixafor (Mozobil) is an agent used to facilitate stem cell collection for autologous hematopoietic cell transplantation (HCT). While it can make the collection process faster, it’s also more expensive.

A study at the Cleveland Clinic examined changes made to HCT collection protocols. Previously, plerixafor was offered to patients who met any of several criteria; the protocol was revised to make patients meet all 3 specific criteria to receive plerixafor.

Daniel Cancilla, MD, a second-year internal medicine resident at Cleveland Clinic, presented the findings at the 2024 Transplantation and Cellular Therapy Tandem Meetings. As expected, fewer patients received plerixafor before their first collection, but overall plerixafor usage was not as low as expected. Further, more collection sessions were needed to get the proper yield for HCT.

The findings, while preliminary, suggest that while plerixafor usage may have decreased, the new protocol may not have achieved the significant cost savings that were initially hoped.

Here, Cancilla discusses the study, highlighting the complex balance between cost and efficiency in healthcare, where changes aimed at reducing expenses may require further evaluation to ensure they achieve their intended goals.


0:05 | I think that needs stems from, you know, plerixafor, it’s not brand new by any means, but relatively new drug in the arsenal of mobilizing agents. So there's no standardized guidelines or universally accepted protocol for the mobilization process. And these practices vary quite widely across different institutions. We’re a large center where we're doing a lot of these transplants and mobilizations. So, you know, sharing our data with our own with 2 different types of regimens that we use, mobilization regimens that we use, and protocols can kind of add to this sort of growing body of literature and hopefully, maybe just get a few steps closer to a more standardized protocol.

0:51 | The goal in the change of protocol was to reduce the amount of plerixafor we gave upfront. And so that was very much achieved. Before this change, maybe in the neighborhood of 80 to 90% of patients are getting plerixafor upfront. And then after the change, only, maybe under 20%, that were getting plerixafor upfront. So that was completely unsurprising. I think what was maybe more surprising was that ultimately, the amount of plerixafor we used was actually not decreased so much.

1:20 | What would happen is patients would get the, you know, the mostly not get plerixafor, and then their collection yield would be not quite adequate. So they would have to get it for subsequent collection sessions. So there was a significant drop in the amount of plerixafor, much less than we expected. What did kind of go up more significantly with the amount of time it took to, for patients to collect their stem cells. So, you know, on an average from maybe a little north of 1 apheresis session per patient went up to you know, north of 2. So, you know, the results are a little preliminary, but based on our initial assessment, it seems maybe the benefits didn't really outweigh the costs.

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