Posted: Wednesday, September 6, 2023
The emergence of effective novel therapies for multiple myeloma has resulted in a decline in the use of cryopreserved autologous peripheral blood hematopoietic cells for salvage autologous transplantation. Ricardo D. Parrondo, MD, of the Mayo Clinic, Jacksonville, Florida, and colleagues conducted a retrospective analysis to evaluate the trends and associated costs of collection, storage, and use of such cells. Their findings, which were published in the journal Bone Marrow Transplantation, may prompt a reevaluation of the current practice guidelines for optimal allocation of health-care resources.
“Our study demonstrates that in patients with multiple myeloma, excess autologous peripheral blood hematopoietic cells collected at the time of the first autologous transplant are most often not utilized for a salvage transplant,” the investigators commented. “This ongoing practice is incurring extra costs borne by institutions.”
The investigators evaluated the clinicopathologic data from 440 patients who underwent autologous peripheral blood hematopoietic cell mobilization and collection at Mayo Clinic Florida between 2010 and 2019. The costs of one session of collection and apheresis and 1 year of cryopreservation were $4,680 and $4,790 per patient, respectively, based on the institution-specific charges as of May 2021. Of the 347 patients who had autologous peripheral blood hematopoietic cells in cryopreservation, 1.4% underwent salvage autologous transplantation, and 61.0% had at least one excess collection session for cells that ultimately went unused. The median cost of excess collection sessions with and without storage were $23,840 and $4,680, respectively, per patient. The sum of costs was $2,077,920 for excess collection sessions and $5,812,665 for cryopreservation.
“The improved survival rates offered by the rapidly evolving new cellular and immunotherapies, as well as the declining trend of performing salvage autologous transplant warrant reconsideration of autologous peripheral blood hematopoietic cells collection goals and guidelines by multiple myeloma transplantation centers and working groups,” the investigators concluded.
Disclosure: For full disclosures of the study authors, visit nature.com.