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CBeV (cyclophosphamide, bendamustine and etoposide) pre-autotransplant conditioning in persons with lymphoma

Bone Marrow Transplantation volume 55, pages 265–267 (2020)Cite this article

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Autotransplants are widely-used in persons with lymphoma. There are two common pretransplant conditioning regimens: CBV (cyclophosphamide, carmustine, and etoposide); and BEAM (carmustine, etoposide, cytarabine and melphalan) [1, 2]. Despite many attempts to increase the efficacy and/or decrease the toxicity of these and other conditioning regimens none is proved convincingly safer and/or more effective [3,4,5,6,7,8].

Unavailability of carmustine in Argentina 2012–2017 led us to develop a new autotransplant conditioning regimen resembling CBV but substituting bendamustine for carmustine (CBeV). Bendamustine is an alkylating drug which in equitoxic doses induces more double-strand DNA breaks than melphalan, cyclophosphamide or carmustine. It also has anti-metabolite activity and a toxicity pattern different from carmustine [9, 10]. Bendamustine is active in early and advanced lymphomas including Hodgkin lymphoma [11, 12] and has been substituted for carmustine in several BEAM-type autotransplant conditioning regimens [8, 13]. We conducted a prospective multi-centre phase-2 study to evaluate safety and efficacy of CBeV in 115 consecutive subjects with lymphomas at five transplant centres December 2014 to April 2018. Subjects must have had adequate heart, lung, liver and kidney (eGFR > 50 ml/min) function. The study was approved by the Anchorena Hospital Ethics Committee. All subjects provided written informed consent. CBeV consists of bendamustine (Bendavar®), 200 mg/mE+2, on days −6 and −5, cyclophosphamide, 1.5 g/mE+2, on days −6 to −3 and etoposide, 1 g/mE+9, on days −6 to −4. Eleven subjects received cyclophosphamide, 4 g/mE+2 total dose, and etoposide, 2.4 g/mE+2 total dose. Hydration of 2 l/ mE+2 was employed during conditioning administration. Filgrastim, 5 μg/kg/d, was given post-transplant until granulocytes were ≥4 × 10E + 9/L.

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Acknowledgements

Statistical support was provided, in part, by Varifarma Argentina. RPG acknowledges support from the National Institute of Health Research (NIHR) Biomedical Research Centre funding scheme.

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Authors and Affiliations

  1. Favaloro University Hospital, Buenos Aires, Argentina

    Gregorio Jaimovich, Agustina Cia & Francisco Lastiri

  2. Anchorena Hospital, Buenos Aires, Argentina

    Gregorio Jaimovich & Martin Castro

  3. Clinicas University Hospital Jose de San Martin, Buenos Aires, Argentina

    Maria Belen Rosales Ostriz & Hector Longoni

  4. CEMIC, Buenos Aires, Argentina

    Leandro Riera & Patricio Duarte

  5. Alexander Fleming Institute, Buenos Aires, Argentina

    Cecilia Foncuberta & Adriana Vitriu

  6. Haematology Research Centre, Imperial College London, London, UK

    Robert Peter Gale

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  1. Gregorio Jaimovich
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Correspondence to Gregorio Jaimovich.

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The authors had full access to the data and freedom in the decision to publish. RPG is apart-time employee of Celgene Corp.

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Jaimovich, G., Ostriz, M.B.R., Castro, M. et al. CBeV (cyclophosphamide, bendamustine and etoposide) pre-autotransplant conditioning in persons with lymphoma. Bone Marrow Transplant 55, 265–267 (2020). https://doi.org/10.1038/s41409-019-0528-y

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