Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

BEAM or BUCYVP16-conditioning regimen for autologous stem-cell transplantation in non-Hodgkin’s lymphomas

Bone Marrow Transplantation volume 54, pages 1553–1561 (2019)Cite this article

Subjects

Abstract

High-dose chemotherapy followed by autologous hematopoietic cell transplantation (AHCT) is an effective salvage therapy for patients with relapsed chemosensitive non-Hodgkin’s lymphoma (NHL). However, the optimal conditioning regimen is unclear. Different conditioning regimens prior to AHCT have been used with the two most common being BEAM (carmustine, etoposide, cytarabine, and melphalan) and BUCYVP16 (busulfan, cyclophosphamide, and etoposide). We sought to compare the two regimens for patients with relapsed NHL undergoing AHCT. We retrospectively compared the outcomes of patients treated with BEAM (N = 269) at The Ohio State University and BUCYVP16 (N = 409) at the Cleveland Clinic followed by AHCT between 2006 and 2014. The primary endpoints were progression-free survival (PFS), overall survival (OS), and cumulative incidence of relapse (CIR). Patient characteristics between the two groups were similar. After a median follow-up of 3.9 years for BEAM and 4.3 years for BUCYVP16 from AHCT, the rate of relapse (p = 0.69), PFS (p = 0.52), and OS (p = 0.11) were similar between the two conditioning regimens. No differences in survival outcomes were seen in disease subtypes. Multivariable analysis showed significant association toward improved OS with BEAM (HR: 1.56, 95% CI 1.16–2.10) (p < 0.01). Even though the study is limited by its retrospective nature and some differences in cohort, the findings indicate that BEAM could serve as an alternative conditioning regimen prior to AHCT for NHL.

Key points

  • BEAM and BUCYVP16 are equally effective as conditioning regimens prior to autologous stem cell transplant for non-Hodgkins lymphoma.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Armitage JO, Fyfe MA, Lewis J. Long-term remission durability and functional status of patients treated for diffuse histiocytic lymphoma with the CHOP regimen. J Clin Oncol. 1984;2:898–902. https://doi.org/10.1200/jco.1984.2.8.898.

    Article  CAS  PubMed  Google Scholar 

  2. Shankland KR, Armitage JO, Hancock BW. Non-Hodgkin lymphoma. Lancet. 2012;380:848–57. https://doi.org/10.1016/s0140-6736(12)60605-9.

    Article  PubMed  Google Scholar 

  3. MA S, DP H, JR A. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1993;329:987–94. https://doi.org/10.1056/nejm199309303291402.

    Article  Google Scholar 

  4. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. N Engl J Med. 1995;333:1540–5. https://doi.org/10.1056/nejm199512073332305.

    Article  CAS  PubMed  Google Scholar 

  5. Ziepert M, Hasenclever D, Kuhnt E, Glass B, Schmitz N, Pfreundschuh M, et al. Standard International prognostic index remains a valid predictor of outcome for patients with aggressive CD20+B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28:2373–80. https://doi.org/10.1200/jco.2009.26.2493.

    Article  CAS  PubMed  Google Scholar 

  6. Caballero MD, Rubio V, Rifon J, Heras I, Garcia-Sanz R, Vazquez L, et al. BEAM chemotherapy followed by autologous stem cell support in lymphoma patients: analysis of efficacy, toxicity and prognostic factors. Bone Marrow Transplant. 1997;20:451–8. https://doi.org/10.1038/sj.bmt.1700913.

    Article  CAS  PubMed  Google Scholar 

  7. Mills W, Chopra R, McMillan A, Pearce R, Linch DC, Goldstone AH. BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin’s lymphoma. J Clin Oncol. 1995;13:588–95. https://doi.org/10.1200/jco.1995.13.3.588.

    Article  CAS  PubMed  Google Scholar 

  8. Copelan EA, Penza SL, Pohlman B, Avalos BR, Goormastic M, Andresen SW, et al. Autotransplantation following busulfan, etoposide and cyclophosphamide in patients with non-Hodgkin’s lymphoma. Bone Marrow Transplant. 2000;25:1243–8. https://doi.org/10.1038/sj.bmt.1702433.

    Article  CAS  PubMed  Google Scholar 

  9. Stiff PJ, Dahlberg S, Forman SJ, McCall AR, Horning SJ, Nademanee AP, et al. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive non-Hodgkin’s lymphoma: value of augmented preparative regimens--a Southwest Oncology Group trial. J Clin Oncol. 1998;16:48–55. https://doi.org/10.1200/jco.1998.16.1.48.

    Article  CAS  PubMed  Google Scholar 

  10. Sakellari I, Mallouri D, Batsis I, Apostolou C, Konstantinou V, Abela EM, et al. Carmustine, etoposide, cytarabine and melphalan versus a newly designed intravenous busulfan-based Busulfex, etoposide and melphalan conditioning regimen for autologous hematopoietic cell transplant: a retrospective matched-pair analysis in advanced Hodgkin and non-Hodgkin lymphomas. Leuk Lymphoma. 2015;56:3071–81. https://doi.org/10.3109/10428194.2015.1028054.

    Article  CAS  PubMed  Google Scholar 

  11. Hanel M, Kroger N, Sonnenberg S, Bornhauser M, Kruger W, Kroschinsky F, et al. Busulfan, cyclophosphamide, and etoposide as high-dose conditioning regimen in patients with malignant lymphoma. Ann Hematol. 2002;81:96–102. https://doi.org/10.1007/s00277-001-0413-8.

    Article  CAS  PubMed  Google Scholar 

  12. Aggarwal C, Gupta S, Vaughan WP, Saylors GB, Salzman DE, Katz RO, et al. Improved outcomes in intermediate- and high-risk aggressive non-Hodgkin lymphoma after autologous hematopoietic stem cell transplantation substituting intravenous for oral busulfan in a busulfan, cyclophosphamide, and etoposide preparative regimen. Biol Blood Marrow Transplant. 2006;12:770–7. https://doi.org/10.1016/j.bbmt.2006.03.016.

    Article  CAS  PubMed  Google Scholar 

  13. Andion M, Molina B, Gonzalez-Vicent M, Alonso L, Hernandez C, Lassaletta A, et al. High-dose busulfan and cyclophosphamide as a conditioning regimen for autologous peripheral blood stem cell transplantation in childhood non-Hodgkin lymphoma patients: a long-term follow-up study. J Pediatr Hematol Oncol. 2011;33:e89–91. https://doi.org/10.1097/MPH.0b013e3181fd6c79.

    Article  CAS  PubMed  Google Scholar 

  14. Dean RM, Pohlman B, Sweetenham JW, Sobecks RM, Kalaycio ME, Smith SD, et al. Superior survival after replacing oral with intravenous busulfan in autologous stem cell transplantation for non-Hodgkin lymphoma with busulfan, cyclophosphamide and etoposide. Br J Haematol. 2010;148:226–34. https://doi.org/10.1111/j.1365-2141.2009.07940.x.

    Article  CAS  PubMed  Google Scholar 

  15. Kim JG, Sohn SK, Chae YS, Yang DH, Lee JJ, Kim HJ, et al. Multicenter study of intravenous busulfan, cyclophosphamide, and etoposide (i.v. Bu/Cy/E) as conditioning regimen for autologous stem cell transplantation in patients with non-Hodgkin’s lymphoma. Bone Marrow Transplant. 2007;40:919–24. https://doi.org/10.1038/sj.bmt.1705841.

    Article  CAS  PubMed  Google Scholar 

  16. Wang EH, Chen YA, Corringham S, Bashey A, Holman P, Ball ED, et al. High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma. Bone Marrow Transplant. 2004;34:581–7. https://doi.org/10.1038/sj.bmt.1704637.

    Article  CAS  PubMed  Google Scholar 

  17. Zaucha R, Gooley T, Holmberg L, Gopal AK, Press O, Maloney D, et al. High-dose chemotherapy with BEAM or Busulphan/Melphalan and Thiotepa followed by hematopoietic cell transplantation in malignant lymphoma. Leuk Lymphoma. 2008;49:1899–906. https://doi.org/10.1080/10428190802340184.

    Article  CAS  PubMed  Google Scholar 

  18. Jantunen E, Kuittinen T, Nousiainen T. BEAC or BEAM for high-dose therapy in patients with non-Hodgkin’s lymphoma? A single centre analysis on toxicity and efficacy. Leuk Lymphoma. 2003;44:1151–8. https://doi.org/10.1080/1042819031000083028.

    Article  CAS  PubMed  Google Scholar 

  19. Kim JE, Lee DH, Yoo C, Kim S, Kim SW, Lee JS, et al. BEAM or BuCyE high-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin’s lymphoma patients: a single center comparative analysis of efficacy and toxicity. Leuk Res. 2011;35:183–7. https://doi.org/10.1016/j.leukres.2010.07.016.

    Article  CAS  PubMed  Google Scholar 

  20. Flowers CR, Costa LJ, Pasquini MC, Le-Rademacher J, Lill M, Shore TB, et al. Efficacy of pharmacokinetics-directed busulfan, cyclophosphamide, and etoposide conditioning and autologous stem cell transplantation for lymphoma: comparison of a multicenter phase II study and CIBMTR outcomes. Biol Blood Marrow Transplant. 2016;22:1197–205. https://doi.org/10.1016/j.bbmt.2016.03.018.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM. et al. NCI Sponsored International Working Group. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. J Clin Oncol. 1999;17:1244 https://doi.org/10.1200/jco.1999.17.4.1244.

    Article  CAS  PubMed  Google Scholar 

  22. Vose JM, Rizzo DJ, Tao-Wu J, Armitage JO, Bashey A, Burns LJ, et al. Autologous transplantation for diffuse aggressive non-Hodgkin lymphoma in first relapse or second remission. Biol Blood Marrow Transplant. 2004;10:116–27. https://doi.org/10.1016/j.bbmt.2003.09.015.

    Article  PubMed  Google Scholar 

  23. Shipp MA, Abeloff MD, Antman KH, Carroll G, Hagenbeek A, Loeffler, et al. International consensus conference on high-dose therapy with hematopoietic stem cell transplantation in aggressive non-Hodgkin’s Lymphomas: report of the jury. J Clin Oncol. 1999;17:423–9. https://doi.org/10.1200/jco.1999.17.1.423.

    Article  CAS  PubMed  Google Scholar 

  24. Gisselbrecht C, Schmitz N, Mounier N, Singh Gill D, Linch DC, Trneny M, et al. Rituximab maintenance therapy after autologous stem-cell transplantation in patients with relapsed CD20(+) diffuse large B-cell lymphoma: final analysis of the collaborative trial in relapsed aggressive lymphoma. J Clin Oncol. 2012;30:4462–9. https://doi.org/10.1200/jco.2012.41.9416.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Haioun C, Mounier N, Emile JF, Ranta D, Coiffier B, Tilly H, et al. Rituximab versus observation after high-dose consolidative first-line chemotherapy with autologous stem-cell transplantation in patients with poor-risk diffuse large B-cell lymphoma. Ann Oncol. 2009;20:1985–92. https://doi.org/10.1093/annonc/mdp237.

    Article  CAS  PubMed  Google Scholar 

  26. Hill BT, Rybicki L, Carlstrom KD, Jagadeesh D, Gerds A, Hamilton B, et al. Daily weight-based busulfan with cyclophosphamide and etoposide produces comparable outcomes to four-times-daily busulfan dosing for lymphoma patients undergoing autologous stem cell transplantation. Biol Blood Marrow Transplant. 2016;22:1588–95. https://doi.org/10.1016/j.bbmt.2016.06.011.

    Article  CAS  PubMed  Google Scholar 

Download references

Authors contribution

YE and SS designed research study; SS and QZ analyzed the results; NS and YE wrote the paper; PE, DA, and SS collected the data; MK, SD, and NM edited and provided scientific discussions; RD, CH, DB, AR, SP, LA, SV, SJ, BW, BB, BP, DJ, BH, and RS all reviewed and provided scientific discussions.

Author information

Author notes

  1. These authors contributed equally: Sara Singer, Nidhi Sharma

Authors and Affiliations

  1. Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH, USA

    Sara Singer & Steven M. Devine

  2. Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Nidhi Sharma, Qiuhong Zhao, Patrick Elder, Craig C. Hofmeister, Don M. Benson, Ashley Rosko, Sam Penza, Leslie Andritsos, Sumithira Vasu, Samantha Jaglowski, Basem M. William & Yvonne A. Efebera

  3. Blood and Marrow Transplant Program, Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA

    Robert Dean, Donna Abounader, Brian Bolwell, Brad Pohlman, Matt Kalaycio, Deepa Jagadeesh, Brian Hill, Ronald Sobecks & Navneet S. Majhail

Authors
  1. Sara Singer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nidhi Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Dean
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qiuhong Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Donna Abounader
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick Elder
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Craig C. Hofmeister
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Don M. Benson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ashley Rosko
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sam Penza
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Leslie Andritsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sumithira Vasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Samantha Jaglowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Basem M. William
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Brian Bolwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Brad Pohlman
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Matt Kalaycio
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Deepa Jagadeesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Brian Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Ronald Sobecks
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Steven M. Devine
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Navneet S. Majhail
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Yvonne A. Efebera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yvonne A. Efebera.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singer, S., Sharma, N., Dean, R. et al. BEAM or BUCYVP16-conditioning regimen for autologous stem-cell transplantation in non-Hodgkin’s lymphomas. Bone Marrow Transplant 54, 1553–1561 (2019). https://doi.org/10.1038/s41409-019-0463-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-019-0463-y

Search

Advanced search

Quick links