EPO in combination with G-CSF improves mobilization effectiveness after chemotherapy with ifosfamide, epirubicin and etoposide and reduces costs during mobilization and transplantation of autologous hematopoietic progenitor cells

A successful stem cell harvest is a prerequisite for peripheral blood SCT. We investigated the number of CD34 + cells mobilized, the number of leukaphereses needed and the expenses of treatment for 28 patients with multiple myeloma randomly assigned to receive either G-CSF alone or G-CSF+EPO for stem cell mobilization after chemotherapy with ifosfamide, epirubicin and etoposide. All patients treated with G-CSF+EPO reached the threshold of 6 × 10 6 CD34 + cells per kg body weight (kgbw), with a mean of 1.3 leukaphereses. On average 15.4 × 10 6 CD34 + cells/kgbw were collected. In the G-CSF-alone group, the mean number of leukaphereses was 1.8, and 12.6 × 10 6 CD34 + cells/kgbw were collected, and two patients failed the threshold. Overall costs per patient for mobilization and leukaphereses were €8339 (G-CSF+EPO) and €8842 (G-CSF). After transplantation, fewer blood transfusions (0.6 versus 1.3, P =0.05), fewer days on antibiotics (2.3 versus 6.1, P =0.02) and a shorter hospital stay (15.2 versus 17.8, P =0.06) were noted in the G-CSF+EPO group resulting in a 19.2% reduction of costs for each transplant ( P =0.018). In summary, EPO improves the mobilization efficiency of G-CSF and so reduces costs of mobilization and SCT.