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

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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.

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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.

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Correspondence to Yvonne A. Efebera.

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