Fotemustine plus etoposide, cytarabine and melphalan (FEAM) as a new conditioning regimen for lymphoma patients undergoing auto-SCT: a multicenter feasibility study

doi:doi:10.1038/bmt.2009.318

Bone Marrow Transplantation advance online publication 9 November 2009; doi: 10.1038/bmt.2009.318

Fotemustine plus etoposide, cytarabine and melphalan (FEAM) as a new conditioning regimen for lymphoma patients undergoing auto-SCT: a multicenter feasibility study

M Musso¹, R Scalone¹, G Marcacci², F Lanza³, N Di Renzo⁴, N Cascavilla⁵, P Di Bartolomeo⁶, A Crescimanno¹, T Perrone⁷ and A Pinto²

¹Department of Oncology, Oncohematology and Bone Marrow Transplantation Unit, 'La Maddalena', Palermo, Italy
²Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione 'G Pascale', IRCCS, Naples, Italy
³Section of Hematology, University Hospital, St Anna Hospital, Ferrara, Italy
⁴Hematology Unit, 'Vito Fazi' Hospital, Lecce, Italy
⁵Hematology Unit and Bone Marrow Transplantation, IRCSS 'Casa Sollievo della Sofferenza', San Giovanni Rotondo (FG), Italy
⁶Department of Hematology, Bone Marrow Transplant Centre, Ospedale Civile, Pescara, Italy
⁷Scientific Department, Italfarmaco S.p.A, Cinisello Balsamo (MI), Italy

Correspondence: Dr M Musso, Department of Oncology, Oncohematology and BMT Unit 'La Maddalena', Via San Lorenzo Colli 312/D, I-90146, Palermo, Italy. E-mail: mamusso@libero.it

Received 14 April 2009; Revised 17 September 2009; Accepted 29 September 2009; Published online 9 November 2009.

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Abstract

BEAM is a widely used conditioning regimen for relapsed/refractory lymphoma patients undergoing auto-SCT. We conducted a multicenter study with an alternative regimen (fotemustine plus etoposide, cytarabine and melphalan (FEAM)) in which BCNU was substituted by the chloroethylnitrosourea fotemustine (FTM). Eighty-four patients with relapsed/refractory Hodgkin's (n=20) and non-Hodgkin's lymphoma (n=64) were conditioned with a FEAM regimen (FTM 150 mg/m² on days –7, –6, etoposide 200 mg/m² and cytarabine 400 mg/m² on days –5, –4, –3, –2 and melphalan 140 mg/m² on day –1). Patients were evaluated for toxicity and engraftment parameters. Median times to neutrophil (>500 $times$ 10⁹/l) and plt (>20 000 $times$ 10⁹/l) engraftment were 11 and 13 days, respectively. Grade 3 mucositis occurred in 19 patients (23%), while G3 nausea/vomiting and G3 diarrhea were observed in 13 (15%) and 6 (7%) patients, respectively. No severe hepatic, renal or pulmonary toxicity was detected. Seven patients (7%) experienced G4 mucositis, while no other G4 toxicities or unexpected adverse events of any grade were recorded. Transplant-related mortality was 2.4%. We conclude that a FEAM regimen is feasible and safe. Although toxicity and engraftment times compared favorably with BEAM, longer follow-up is needed to evaluate fully its efficacy and long-term safety.