Benda‐EAM prior to ASCT and renal toxicity: Much ado about nothing

Isidori, Alessandro; Loscocco, Federica; Guiducci, Barbara; Visani, Giuseppe

doi:10.1002/ajh.25413

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…Bendamustine was administered at a median dosage of 196 mg/m 2 /day on days –7 and –6. The study found a rate of all-grade acute renal failure of 27.9%, the admission rate to the intensive care unit (ICU) for patients treated with BeEAM conditioning was high (24%) 43 , but these results were argued by Isidori et al 44 based upon following reasons: (1) The French experience was not a multicenter study, but rather retrospective data collection made from at least 22 French sites. Every transplant site had a different policy in terms of hydration, prophylaxis of infections, supportive care, and management of post-transplant complications.…”

Section: Discussionmentioning

confidence: 99%

BeEAM (Bendamustine, Etoposide, Cytarabine, Melphalan) Versus BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) as Conditioning Regimen Before Autologous Haematopoietic Cell Transplantation: A Systematic Review and Meta-Analysis

2023

Cell Transplant

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High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard of care for selected patients with refractory/relapsed Hodgkin’s lymphoma (HL) or non-Hodgkin’s lymphoma (NHL), and it is also used as first-line clinical consolidation option for some aggressive NHL subtypes. Conditioning regimen prior to ASCT is one of the essential factors related with clinical outcomes post transplant. The conditioning regimen of carmustine, etoposide, cytarabine, and melphalan (BEAM) traditionally is considered the standard of care for patients with lymphoma who are eligible for transplantation. Replacement of carmustine with bendamustine (BeEAM) was described as an alternative conditioning regimen in the autograft setting for patients with lymphoma. Several studies have reported inconsistent clinical outcomes comparing BeEAM and BEAM. Therefore, in the lack of well-designed prospective comparative studies, the comparison of BeEAM versus BEAM is based on retrospective trials. To compare the clinical outcomes between BeEAM and BEAM, we performed a meta-analysis of 10 studies which compared the outcomes between BeEAM and BEAM in patients autografted for lymphoma disease (HL or NHL). We searched article titles and compared transplantation with BeEAM versus BEAM in MEDLINE (PubMed), Cochrane library, and EMBASE database. Here, we report the results of nine main endpoints in our meta-analysis comparing BeEAM and BEAM, including neutrophil engraftment (NE), platelet engraftment (PE), overall survival (OS), progression free survival (PFS), non-relapse mortality (NRM), relapse rate (RR), grade 3 mucositis, renal toxicity, and cardiotoxicity. We discovered that the BeEAM regimen was associated with a slightly better PFS [pooled odds ratio (OR) of 0.70, 95% confidence interval (CI), 0.52–0.94, P = 0.02], lower RR (0.49, 95% CI, 0.31–0.76, P = 0.002), higher mucositis (3.43, 95% CI, 2.29–5.16, P = 0.001), renal toxicity (4.49, 95% CI, 2.68–7.51, P = 0.001), and cardiotoxicity (1.88, 95% CI, 1.03–3.40, P = 0.03). We also discovered that the two groups had equivalent NE (pooled WMD –0.64, 95% CI, –1.46 to 0.18, P = 0.13), PE (pooled WMD –0.3, 95% CI, –1.68 to 2.28, P = 0.77), OS (0.73, 95% CI, 0.52–1.01, P = 0.07), and NRM (1.51, 95% CI, 0.76–2.98, P = 0.24). The results of this meta-analysis show that the BeEAM regimen is a viable alternative to BEAM. More prospective comparisons between BeEAM and BEAM are required.

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Section: Discussionmentioning

confidence: 99%

BeEAM (Bendamustine, Etoposide, Cytarabine, Melphalan) Versus BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) as Conditioning Regimen Before Autologous Haematopoietic Cell Transplantation: A Systematic Review and Meta-Analysis

2023

Cell Transplant

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Be ever cautious until the truth is proven

2019

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We would like to thank Dr. Isidori et al 1 for their interest in our study. 2 We do agree that the best way to come to a definitive conclusion for a conditioning regimen-the focus of our article-is a prospective and randomized trial. Unfortunately, over the last decades, the medical community has not been able to perform this kind of trial in either the autologous or the allogeneic stem cell transplant setting and instead we were satisfied by a small and heterogeneous phase II studies.

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Benda‐EAM prior to ASCT and renal toxicity: Much ado about nothing

Cited by 2 publications

References 6 publications

BeEAM (Bendamustine, Etoposide, Cytarabine, Melphalan) Versus BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) as Conditioning Regimen Before Autologous Haematopoietic Cell Transplantation: A Systematic Review and Meta-Analysis

BeEAM (Bendamustine, Etoposide, Cytarabine, Melphalan) Versus BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) as Conditioning Regimen Before Autologous Haematopoietic Cell Transplantation: A Systematic Review and Meta-Analysis

Be ever cautious until the truth is proven

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