Development and Usage of Algorithms Demonstrate Cost Savings and Increased Efficiency in Peripheral Blood Stem Cell Mobilization and Collection

Topic Significance & Study Purpose/Background/Rationale 

Recent guidelines from the American Society for Blood and Marrow Transplantation indicate that developing algorithms may increase efficiency and decrease costs for mobilization and collection of peripheral blood stem cells (PBSC).   A historical review of adult autologous PBSC collection data at this institution showed signification variation in mobilization methods, collection parameters, and usage of plerixafor.  The mean number of collections per patient was 3, range 1-10.  The cost of mobilization and collection per patient ranged from $9,800 to $74,600.

Methods, Intervention, & Analysis 

Patients in the historical review were divided into groups by total amount (dose) of CD34+ cells infused.  Time to engraftment, length of stay (LOS), and survival were reviewed for each group of patients.  Target and minimum CD34+ cell dose were determined.  Peripheral blood (PB) CD34+ cell screen was correlated with dose CD34+ cells collected.  A minimum PB CD34+ cell screen was identified to begin collections.  Amount of cells collected per each apheresis was analyzed to determine at what point collections should cease and a different mobilization or collection method considered.  The entire workflow for mobilization and collection was reviewed and streamlined.  Algorithms were developed for the primary mobilization methods:  1) filgrastim alone and 2) chemotherapy plus filgrastim.  The algorithms included when to start and stop collecting, if and when to start plerixafor, and when to re-evaluate the mobilization method.

Findings & Interpretation 

Results were analyzed at 6 months and 1 year following implementation of the algorithms.  The one year review of 78 patients’ collections revealed that the algorithms were followed in 76/78 patients.  The majority of the patients, 88.5%, were able to collect in 3 or few collections, mean = 1.5, range =1-5, 50% collected in 1 collection.  Engraftment and LOS was found to be similar to the historical controls.  Overall, the cost savings for the 78 patients in this review was approximately $741,000.  Workflow changes were accommodated without added cost.

Discussion & Implications 

Usage of algorithms for mobilization and collection for autologous patients helps to standardize practice, decrease cost, and increase efficiency.  The algorithms also provide autonomy for transplant nurse coordinators managing the patients during the collection and clarity to the entire mobilization and collection team.