Autologous SCT with a dose-reduced BU and CY regimen in older patients with non-Hodgkin's lymphoma

Abstract

Autologous SCT is a potentially curative procedure for patients with relapsed lymphoma (NHL). We analyzed the outcomes of 34 patients X60 years old, including eight patients X70 years old, who received BU and CY and SCT for NHL. Patients received BU 0.8 mg/kg i.v. (n ¼ 25) or 1 mg/kg p.o. (n ¼ 9) q 6 h  14 doses and CY 60 mg/kg i.v. q day  2 days. The median age was 66 (range, 60-78) years. Twenty-two patients had large cell, 10 follicular and two-mantle cell lymphoma. Fifteen patients were in a second or greater CR and 19 patients were in a PR. The median days to ANC 4500/ll and platelet count 450 000/ll were 10 and 13 days respectively. The 100-day transplant-related mortality was 0%. Toxicities included interstitial lung disease (n ¼ 2), seizures in a patient with CNS lymphoma (n ¼ 1), mild veno-occlusive disease (n ¼ 2), and transient atrial fibrillation (n ¼ 4). With a median follow-up of 40 months, the 2-year overall survival and PFS were 67 and 54% respectively. BU/CY is a well-tolerated conditioning regimen for older patients with NHL. Age alone should not be used as an exclusion criterion for autologous SCT.

Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: a retrospective study from the EBMT

“…Other efficient alternatives to BEAM are busulfan and cyclophosphamide with or without etoposide. [27][28][29][30] In a recent large registry study with 4917 patients with lymphoma, outcomes of various commonly used high-dose regimens (BEAM, cyclophosphamide/ carmustine/etoposide, busulfan/cyclophosphamide, TBI-based), several significant but often only subtle outcome differences between different HDT platforms were found in individual non-Hodgkin lymphoma subsets. 31 Similarly, slight differences may exist between the comparators of the present study, which can be only detected on the basis of much larger samples or by prospective studies.…”

BeEAM (bendamustine, etoposide, cytarabine, melphalan) before autologous stem cell transplantation is safe and effective for resistant/relapsed lymphoma patients

“…The extremely low-toxicity profile of the "Supercharge BeEAM" needs to be adequately underlined, especially if we bear in mind that the study population was pretreated with a median number of 2 lines of therapy. Furthermore, the toxicity of regimens considered safer than BCNU-containing schedules (eg, intravenous busulfan and cyclophosphamide) are greater if compared with BeEAM, with a reported 100-day TRM between 0% and 10% among the studies [37][38][39][40] and with an incidence of approximately 20% of mild-to-severe clinically relevant side effects (eg, seizures, interstitial pneumonia, veno-occlusive disease). We reported a cumulative incidence of infectious complications (bacteremia plus fever of unknown origin) of approximately 60%, which is greater than other series, but we did not observe any of the serious adverse events reported with other schedules.…”

Carmustine, etoposide, cytarabine and melphalan versus a newly designed intravenous busulfan-based Busulfex, etoposide and melphalan conditioning regimen for autologous hematopoietic cell transplant: a retrospective matched-pair analysis in advanced Hodgkin and non-Hodgkin lymphomas

“…Some representative studies have employed busulfan for NHL in various combinations, either as bulslfan-melphalan, BuCy2 or BuCy/VP16 followed by AHCT, and their experience demonstrates evidence of anti-lymphoma activity. PFS rates range from 35 to 73% [33][34][35][36][37][38].…”