BEAM versus BUCYVP16 Conditioning before Autologous Hematopoietic Stem Cell Transplant in Patients with Hodgkin Lymphoma

Singer, Sara; Dean, Robert M.; Zhao, Qiuhong; Sharma, Nidhi; Abounader, Donna; Elder, Patrick; Hofmeister, Craig C.; Benson, Don M.; Rosko, Ashley; Penza, Sam; Andritsos, Leslie A.; Vasu, Sumithira; Jaglowski, Samantha; William, Basem M.; Bolwell, Brian J.; Pohlman, Brad; Kalaycio, Matt; Jagadeesh, Deepa; Hill, Brian T.; Sobecks, Ronald; Devine, Steven M.; Majhail, Navneet S.; Efebera, Yvonne A.

doi:10.1016/j.bbmt.2019.01.032

Cited by 9 publications

(4 citation statements)

References 17 publications

(13 reference statements)

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“…A multi-center French retrospective registry study of 91 patients aged 60 or older primarily conditioned with BEAM followed by autoHCT demonstrated a 5-year OS of 67% ( 28 ). These findings compare favorably to a cohort that included a broad age-range of patients ( 18 – 73 ) and reported a 5-year OS of 79% with BEAM conditioning ( 29 ).…”

Section: Patient Selection For Autologous Transplantsupporting

confidence: 59%

The role of transplantation in Hodgkin lymphoma

Maranzano

Mead

2023

Front. Oncol.

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Despite the success of frontline anthracycline-based chemotherapy for classical Hodgkin Lymphoma (cHL), approximately 15% of patients do not achieve an adequate response and require further therapy. For transplant-eligible patients, additional treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autoHCT) provides a durable response in 50% of patients. The most refractory patients, including those requiring multiple lines of therapy to achieve a response or those relapsing after an autoHCT, may achieve long-term survival with allogeneic hematopoietic stem cell transplant (alloHCT). Contemporary salvage regimens used as a bridge to transplant have expanded to include not only non-cross resistant chemotherapy, but also brentuximab vedotin (BV) and checkpoint inhibitors (CPI). As the management of relapsed/refractory (R/R) cHL evolves with the introduction of novel agents, so too does the role of transplantation. The paradigm of chemosensitivity as a predictor for autoHCT efficacy is being challenged by favorable post- autoHCT outcomes in heavily pre-treated CPI-exposed patients. Contemporary supportive care measures, validated comorbidity assessments, and an increased donor pool with haploidentical donors have broadened the application of transplantation to an increasingly older and diverse patient population. Despite the introduction of increasingly effective treatment options for R/R cHL, transplantation continues to play an important role in the management of these patients. In this review, we explore the impact of salvage therapy on autoHCT, conditioning regimens, maintenance therapy and the diminishing role of alloHCT for patients with cHL.

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Section: Patient Selection For Autologous Transplantsupporting

confidence: 59%

The role of transplantation in Hodgkin lymphoma

Maranzano

Mead

2023

Front. Oncol.

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“…Patients with mantle cell lymphoma were excluded due to changes in induction regimens during the study period. Patients with Hodgkin lymphoma were excluded because previous studies have demonstrated superior disease control with the use of BEAM compared with Bu/Cy/E [26,27]. Patients were required to have successfully collected a minimum of 2 £ 10 6 CD34 + peripheral stem cells/kg of actual body weight.…”

Section: Patientsmentioning

confidence: 99%

Therapeutic Dose Monitoring of Busulfan Is Associated with Reduced Risk of Relapse in Non-Hodgkin Lymphoma Patients Undergoing Autologous Stem Cell Transplantation

Hill

Rybicki

Urban

et al. 2020

Biology of Blood and Marrow Transplantation

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Optimal administration of busulfan (Bu) is hampered by variable and unpredictable drug metabolism in individual patients. At our institution, Bu was previously administered with fixed weight-based dosing (WBD) in combination with cyclophosphamide (Cy) and etoposide (E) for patients with non-Hodgkin lymphoma (NHL) undergoing autologous stem cell transplantation (ASCT). In 2014, we adopted real-time pharmacokinetic (PK)-guided therapeutic drug monitoring (TDM) of Bu for all NHL patients undergoing Bu-containing ASCT. Here we compare outcomes of NHL patients who underwent ASCT with Bu/Cy/E using WBD and those who did so using TDM of Bu. We studied 336 consecutive adult NHL patients who underwent ASCT with Bu/Cy/E using WBD from January 2007 to December 2013 (n = 258) or TDM from May 2014 to December 2017 (n = 78), excluding patients with mantle cell lymphoma. Clinical outcomes, including relapse, nonrelapse mortality (NRM), progression-free survival (PFS), and overall survival (OS), hepatotoxicity and pulmonary toxicity were compared in the 2 groups. To adjust for differences in baseline characteristics between the groups, propensity-matched cohorts of WBD and TDM patients were also studied. After the first dose of Bu, the dose was increased in 36% of the patients and decreased in 41%. Changes in pulmonary and liver function from baseline to transplantation were not different between the 2 groups, although these changes showed significantly less variability with TDM than with WBD. Relapse was significantly lower and PFS was improved with TDM; 2-year estimates were 19% for TDM and 38% for WBD for relapse (P = .004) and 69% and 55%, respectively, for PFS (P = .038). No significant between-group differences in NRM or OS were seen. In multivariable analysis, TDM remained prognostic for lower risk of relapse (hazard ratio [HR], .52; 95% confidence interval [CI], .30 to .89; P = .018), but did not remain prognostic for PFS (HR, .74; 95% CI, .48 to 1.16; P = .19). Propensity-matched cohorts displayed similar patterns of outcomes. In subset analysis based on disease status at ASCT, TDM was associated with less relapse and better PFS than WBD for patients who underwent transplantation in less than complete remission (CR) compared with those who underwent transplantation in CR. Compared with WBD, PK-directed TDM of Bu reduces the incidence of relapse when used in combination with Cy and E for patients with NHL undergoing ASCT, particularly for patients in less than CR. These data support the continued use of personalized PK-guided dosing for all NHL patients undergoing ASCT with Bu-containing preparative regimens.

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“…For instance, patients with Hodgkin lymphoma receiving carmustine, etoposide, cytarabine, and melphalan (BEAM) as a conditioning regimen had a 5-year PFS of 66% and a 5-year OS of 79%. In contrast, those receiving busulfan, cyclophosphamide, and etoposide (BUCYVP16) had a 5-year PFS of 33% and a 5-year OS of 54% ( 5 ). Standard conditioning regimens for T-cell lymphomas include BEAM, total body irradiation (TBI) with cyclophosphamide, cyclophosphamide, carmustine, etoposide (CBV), BUCYVP16, and others.…”

Section: Introductionmentioning

confidence: 99%

A novel conditioning regimen of chidamide, cladribine, gemcitabine, and busulfan in the autologous stem cell transplantation of aggressive T-cell lymphoma

et al. 2023

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BackgroundThe prognosis of patients with peripheral T-cell (PTCL) or lymphoblastic T-cell lymphoma (T-LBL) remains poor under current conditioning regimens before receiving autologous stem cell transplantation (ASCT).MethodsPatients with PTCL or T-LBL were enrolled to receive ASCT using the conditioning regimen of chidamide, cladribine, gemcitabine, and busulfan (ChiCGB). Positron emission tomography-computed tomography (PET/CT) was used to evaluate the response to ASCT. Overall survival (OS) and progression-free survival (PFS) were employed to assess the patient outcome, and adverse events were used to assess the regimen’s safety. The survival curve was estimated via the Kaplan-Meier method.ResultsTwenty-five PTCL and 11 T-LBL patients were recruited. The median time to neutrophile and platelet engraftments was 10 days (8–13 days) and 13 days (9–31 days), respectively. The 3-year PFS and OS were 81.3 ± 7.2% and 88.5 ± 5.4% for all patients; 92.0 ± 5.4% and 81.2 ± 8.8% for PTCL patients; and both 81.8 ± 11.6% for T-LBL patients, respectively. The 3-year PFS and OS were both 92.9 ± 4.9% for patients with complete response (CR) but 50.0 ± 17.7% and 75.0 ± 15.3% for patients with non-CR, respectively. Infection was the most common non-hematological toxicity, and all toxicities were mild and controllable.ConclusionsChiCGB was a potentially effective and well-tolerated conditioning regimen to improve the prognosis of patients with aggressive T-cell lymphoma. Future randomized controlled trials are needed to assess ChiCGB as a conditioning regimen for ASCT.

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BEAM versus BUCYVP16 Conditioning before Autologous Hematopoietic Stem Cell Transplant in Patients with Hodgkin Lymphoma

Cited by 9 publications

References 17 publications

The role of transplantation in Hodgkin lymphoma

The role of transplantation in Hodgkin lymphoma

Therapeutic Dose Monitoring of Busulfan Is Associated with Reduced Risk of Relapse in Non-Hodgkin Lymphoma Patients Undergoing Autologous Stem Cell Transplantation

A novel conditioning regimen of chidamide, cladribine, gemcitabine, and busulfan in the autologous stem cell transplantation of aggressive T-cell lymphoma

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