Utilization and cost implications for collection and storage of excess autologous hematopoietic stem cells in patients with multiple myeloma.

Abstract

7520 Background: Treatment for transplant-eligible patients with multiple myeloma (MM) is typically induction therapy followed by autologous hematopoietic cell transplantation (autoHCT). Guidelines recommend leukapheresis to collect sufficient hematopoietic progenitor cells (HPCs) for initial and potential second autoHCT. But with novel immune effector therapies, the need for salvage autoHCT has decreased. HPC mobilization and collection are resource-intensive, both in time and costs. We aimed to assess the utilization and costs of cryopreserved HPCs stored for potential second autoHCTs at our center to evaluate the impact for adopting a single-transplant collection strategy for all MM patients. Methods: We conducted a retrospective study using clinical and laboratory databases at a small transplant center in upper Midwest. A total of 97 patients (age ≥18 years) with confirmed diagnosis of MM who underwent HPC mobilization and collection between 2013 and 2023 were included. We extracted demographical patient information as well as clinical data including disease characteristics, previous lines of therapies, number of mobilization and apheresis sessions, and number of CD34 cells/kg collected, used, and stored. As part of our quality improvement, we proposed a target collection goal of ≥3.5x10^6 CD34 cells/kg versus current 5-10 x10^6/kg and used this to assess excess HPC apheresis collections. Based on our current institution-specific charges, estimate cost of 1 session of HPC collection was 7625, processing and cryopreservation per product 7792, and storage of excess cells after 1 st transplant 3943 per year. Results: Of the 97 patients who underwent HPC collection for two autoHCTs (mean age at collection 64.5 ±8.7), only 4 (4.1%) underwent a salvage auto-HCT. Based on the proposed reduced collection target, 29 (29.9%) patients had ≥1 excess collection sessions. Among the patients who underwent excess collections, median cost of these collections was 7625 per patient and median cost for processing and cryopreservation of those products was 23,308 per patient. Total cost for the excess collection sessions plus cryopreservation of the cells collected was 871,768. Median number of years of excess HPC cells stored beyond the 1 st transplant but not used was 4 (0.2-11.8), with an estimated median cost of 23,576 per patient. Total storage cost for unnecessary excess HPCs for all patients was 2,471,775. Conclusions: This study demonstrates even for our small center excess HPCs collected during the first autoHCT are rarely used for 2nd or salvage transplant, incurring substantial costs for the institution and patient. Similar to prior HPC utilization studies, our results support changing collection practices for MM patients to improve resource allocation and reduce unnecessary expenditures.