High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma

Abstract

, 72 patients with non-Hodgkin's lymphoma or Hodgkin's disease underwent high-dose chemotherapy with autologous stem cell transplant conditioned with either cyclophosphamide, etoposide, carmustine (CEB) or carmustine, etoposide, cytarabine, melphalan (BEAM) at a single institution. In all, 52 patients received CEB and 20 patients received the BEAM regimen. Patient characteristics that were significantly different between the two groups are tumor grade and extranodal involvement (P ¼ 0.0196, 0.0341, respectively). Regimen-related toxicities examined yielded only diarrhea occurring at a higher rate in the BEAM group (81 vs 51%, P ¼ 0.0026), although cases were milder (92 vs 57%). Patients treated with CEB developed mucositis at a slightly higher rate (79%) than patients treated with BEAM (75%), but this difference did not reach statistical significance. However, the mucositis that occurred within the BEAM group was predominately mild (67%) in contrast to the predominance of moderate to severe cases in the CEB group (74%). In addition, patients treated with CEB required growth factor support for a longer time than patients treated with BEAM (P ¼ 0.0399). Response rates were high in both groups, with trends favoring the BEAM group. Overall survival was higher after treatment with BEAM than with CEB (84 vs 60%). A subset of patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) have been treated with highdose chemotherapy with autologous stem cell transplant (HDC-ASCT). HDC regimens used include cyclophosphamide, etoposide, carmustine (BCNU) (CEB) or BCNU, etoposide, cytarabine (Ara-C), and melphalan (BEAM). In the past, CEB has been more commonly used at our institution; however, in recent years, oncologists are increasingly choosing BEAM to treat patients. The increased use of BEAM emerges from the belief that reduced toxicities are associated with this regimen, namely less mucositis, infection, and BCNU pulmonary fibrosis. A higher dose of BCNU (600 mg/m 2 ) is given as part of the CEB regimen than that given in the BEAM regimen (300 mg/m 2 ). Doses greater than 600 mg/m 2 are not well tolerated with a higher risk of development of posttransplant noninfective pulmonary complications, marked mucositis, and increased cases of infection. [1][2][3][4][5][6] In terms of efficacy, whether CEB or BEAM produces better survival outcome is unclear. There is a wide range of percentages of patients achieving complete remission in both the CEB and BEAM. 2,3,[7][8][9] Overall survival at 5 years seems comparable at 44-53% for CEB patients and 41-55% for BEAM patients. 3,[8][9][10][11] Progression-free survival ranges from 38 to 450% for the CEB group and from 35 to 69% for the BEAM group in various studies. [2][3][4][7][8][9]11 Data directly comparing CEB and BEAM regimens are scarce. In this paper, we present the results of a retrospective study on the toxicity, efficacy, and cost issues associated with the use of CEB and BEAM in patients with NHL or HD. Patients and methods Patient selectionA total of 86 patien...

Mucositis in patients with hematologic malignancies: an overview

“…35 The association of idarubicin with busulfan for autologous SCT in AML patients caused profound mucosal derangement in 82% of patients. 36 High doses of melphalan (200 mg/m 2 ), given prior to autologous SCT for multiple myeloma, caused mucosal injury in about 35% of them; 37 intermediate doses (100 mg/m 2 ) significantly reduced the incidence of mucositis to 23%, as reported in a study including patients over 70 years old.…”

Pain syndromes in the setting of haematopoietic stem cell transplantation for haematological malignancies

“…21 The severity of OM is closely correlated with the conditioning regimen, 22 and has been reported to be as high as 75% in lymphoma patients conditioned with carmustine, etoposide, cytarabine and melphalan regimen. 23 The association of idarubicin with BU for autologous HSCT in patients with AML caused profound mucosal derangement and pain in 82% of patients. 24 In myeloma patients, a high dose (200 mg/m 2 ) of melphalan is associated with a 30-35% incidence of OM.…”

Lymphomas

“…Randomized trials are lacking. In adult studies, 5-year OS is reported at 40-55 % for both regimens, although BEAM has been reported to have a more favorable toxicity profi le than CVB, including less hepatotoxicity, mucositis, and treatment-related mortality (Wang et al 2004 ;Puig et al 2006 ). Attempts to intensify CVB chemotherapy with infusional etoposide and dose escalation of BCNU were associated with improved response rates but a high rate of interstitial pneumonitis (Benekli et al 2008 ).…”