BeEAM conditioning regimen is a safe, efficacious and economical alternative to BEAM chemotherapy

Abstract

In many stem cell transplant centres, BCNU, etoposide, cytarabine and melphalan (BEAM) high-dose chemotherapy (HDCT) has been replaced by the more economic and available bendamustine, etoposide, cytarabine, melphalan (BeEAM) regimen. However, there is a paucity of information on the efficacy and safety of BeEAM HDCT. We describe our experience with BeEAM HDCT in terms of safety, efficacy and cost-savings. We compare overall and progression-free survival to a cohort of patients previously transplanted at our institution with the older BEAM regimen. We performed a retrospective chart review of 41 lymphoma patients undergoing BeEAM HDCT at the Royal University Hospital in Saskatoon, Saskatchewan between 2015 and 2019 to elicit regimen safety in the first 100 days post-transplant. Furthermore, we calculated overall and progression-free survival and constructed corresponding Kaplan–Meier curves, comparing the results to a historical cohort of BEAM patients (n = 86). Finally, we conducted an economic analysis using the financials available at our centre’s pharmacy. With regards to BeEAM HDCT, we report a 100-day transplant-related mortality of 2.4%. Additionally, we report acceptable rates of typhlitis (27%), grade III–IV mucositis (4.9%) and grade III–IV nephrotoxicity (2.4%). In terms of overall and progression-free survival, we found no statistical difference between BeEAM and BEAM (p = 0.296; 0.762, respectively). Finally, our economic analysis revealed a net savings of $21,200 CAD per transplant when BeEAM is used in replacement of BEAM. The acceptable safety profile of BeEAM and its comparable efficacy to BEAM are encouraging for the perseverance of this cost-effective HDCT regimen.

BeEAM High-Dose Chemotherapy with Polatuzumab (Pola-BeEAM) before ASCT in Patients with DLBCL—A Pilot Study

“…Fever in aplasia occurred in all patients (100%), similarly to our previous study (100%) or to Hahn et al (100%) [11,12]. Visani et al reported lower rates of fever in aplasia, with 51% of patients [28].…”

“…In this cohort of 12 patients, we observed an expected range of bacterial, viral and fungal infections with an incidence and severity commonly observed in HDCT patients. The infection rates in this study were higher compared to our previous results (92% after Pola-BeEAM and 79% after BeEAM) [12] and those of other studies reporting on the BeEAM regimen without PV, i.e., Hahn et al (70.7%) [11], Chantepie et al (78.2%) [13] or Visani et al [28], where in only 7% of patients an infection was documented [28]. However, a comparison of the different studies must be performed with caution.…”

“…In particular, we reported similar results in our previous work [12] with regard to hematologic recovery as compared to this study. When compared to other studies such as Hahn et al [11], Chantepie et al [13] and Visani et al [28], where BeEAM was applied predominantly in relapsed or refractory lymphoma patients, the hematological recovery was similar, ranging from a median of 11-13 days for thrombocytes >20 G/L to 10-11.7 days for neutrophils >0.5 G/L. Of particular interest is the analysis of the types and severity of infections following Pola-BeEAM HDCT, given the potential immunosuppressive effect of PV.…”

“…The most commonly applied conditioning regimen before ASCT is the BEAM regimen, comprising BCNU, etoposide, cytarabine and melphalan [10,11]. However, with regard to issues such as idiopathic pneumonia syndrome (IPS), delivery shortages and the rising costs of BCNU, several studies suggested replacing BCNU with bendamustine [11][12][13]. Bendamustine combined with BEAM (BeEAM) was shown to have an acceptable safety profile and a comparable PFS and OS to BEAM [11,12].…”

“…However, with regard to issues such as idiopathic pneumonia syndrome (IPS), delivery shortages and the rising costs of BCNU, several studies suggested replacing BCNU with bendamustine [11][12][13]. Bendamustine combined with BEAM (BeEAM) was shown to have an acceptable safety profile and a comparable PFS and OS to BEAM [11,12]. Nevertheless, progression of the underlying disease remains the major cause of death in relapsing DLBCL patients, and improved efficacy of HDCT is an unmet need.…”