Autologous transplantation for relapsed non-Hodgkin's lymphoma using intravenous busulfan and cyclophosphamide as conditioning regimen: a single center experience

Abstract

High-dose chemotherapy with autologous SCT has become standard of care for patients with relapsed aggressive non-Hodgkin's lymphoma (NHL). To improve safety and efficacy of this treatment, new conditioning regimens are being developed. We retrospectively reviewed clinical data of patients with relapsed NHL treated at our institution with i.v. BU and CY (BU/CY) as conditioning regimen for autologous SCT between January 2000 and April 2005. We identified 43 patients (24 men, 19 women, median age 50) with diffuse large B-cell lymphoma (n ¼ 28), follicular lymphoma (n ¼ 8), mantle cell lymphoma (n ¼ 4) and peripheral T-cell lymphoma (n ¼ 3). Following salvage chemotherapy, there were 26 complete responses, 13 partial responses and 4 stable diseases. Median time to neutrophil and platelet recovery was 11 and 13.5 days, respectively. Treatmentrelated toxicities included nausea/vomiting, diarrhea and mucositis. The 100-day mortality was 9%: sepsis (n ¼ 1), pneumonia (n ¼ 1) and hepatic veno-occlusive disease (n ¼ 2). Twenty-one patients were followed until death and twenty-one surviving patients were followed for a median of 29 months (range 0.4-76). Three-year estimates of event-free survival, progression-free survival and overall survival were 35, 39 and 43%, respectively. We conclude that i.v. BU/CY is a safe and effective conditioning regimen for autologous SCT in relapsed NHL.

Fotemustine plus etoposide, cytarabine and melphalan (FEAM) as a new conditioning regimen for lymphoma patients undergoing auto-SCT: a multicenter feasibility study

“…This is further confirmed by a TRM of 2.4%, which compares favorably with that reported for similar carmustine-based regimens (0 to 11%) and other types of high-dose conditioning (0 to 25%), with variations being mostly related to patient age and/or comorbidity status. [1][2][3][4]22,[28][29][30][40][41][42] Regarding the acute toxicity of FEAM, we observed a relatively high incidence of mucositis, which was, however, equal or higher than G3 severity in only 30% of episodes. Although the design of this study did not foresee comparison with standard BEAM, it is noteworthy that a recent investigation reported that 83% of patients receiving BEAM experienced oral mucositis, which was graded G1/G2 in 42% of cases and G3/G4 in the remaining 41% of patients.…”

Clinical impact and resource utilization after stem cell mobilization failure in patients with multiple myeloma and lymphoma

“…30,31 The data presented here suggest that the fraction of patients that have a lessthan-optimal first collection is substantial: 30% in multiple myeloma, 71% in non-Hodgkin lymphoma, and 57% in Hodgkin disease.…”

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.…”