Bendamustine-EAM versus BEAM regimen in patients with mantle cell lymphoma undergoing autologous stem cell transplantation in the frontline setting: a multicenter retrospective study from Lymphoma Study Association (LYSA) centers


The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) as conditioning regimen prior to autologous stem-cell transplantation (ASCT) remains the standard of care for patients with mantle cell lymphoma (MCL) who are eligible for transplantation. The replacement of carmustine with bendamustine (BeEAM) was described as a promising alternative in non-Hodgkin lymphoma. The aim of this retrospective study was to compare the BeEAM with the BEAM regimen in MCL patients in the frontline setting. Sixty and 108 patients were included in the BeEAM and the BEAM groups, respectively. At 3 years, progression-free survival (PFS) was significantly higher in the BeEAM than in the BEAM group (84% [73–96] vs. 63% [51–79], p = 0.03). The overall survival was not statistically different between the two groups (p = 0.2). In multivariable analysis, BeEAM regimen remained associated with higher PFS (HR = 0.377, 95% CI, 0.146–0.970; p = 0.043). Subgroup analyses in patients treated with prior rituximab–aracytine induction alone showed that BeEAM improved the PFS compared with BEAM regimen (p = 0.04). Despite the high rate of acute renal failure KDIGO III (32%), treatment-related mortality was not increased with the BeEAM regimen. A prospective randomized trial will be necessary to confirm the beneficial effect of the BeEAM regimen in MCL patients undergoing ASCT.

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Fig. 1: Univariable analysis.
Fig. 2: Subgroup analysis according to induction regimen.
Fig. 3: Subgroup analysis in patients without rituximab maintenance.


  1. 1.

    Hoster E, Dreyling M, Klapper W, Gisselbrecht C, Van Hoof A, Kluin-Nelemans HC, et al. A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma. Blood. 2008;111:558–66.

    CAS  Article  Google Scholar 

  2. 2.

    Dreyling M, Lenz G, Hoster E, Van Hoof A, Gisselbrecht C, Schmits R, et al. Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs porgession-free survival in mantle-cell lymphoma: results of prospective randomized trial of the European MCL. Blood. 2005;105:2677–84.

    CAS  Article  Google Scholar 

  3. 3.

    Delarue R, Haioun C, Ribrag V, Brice P, Delmer A, Tilly H, et al. CHOP and DHAP plus rituximab followed by autologous stem cell transplantation in mantle cell lymphoma: a phase 2 from the Groupe d’Etude des Lymphomes de l’Adulte. Blood. 2013;121:48–53.

    CAS  Article  Google Scholar 

  4. 4.

    Hermine O, Hoster E, Walewski J, Bosly A, Stilgenbauer S, Thieblemont C, et al. Addition of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation in patients aged 65 years or younger with mantle cell lymphoma (MCL Younger): a randomised, open-label, phase 3 trial of the European Mantle Cell Lympho. Lancet. 2016;388:565–75.

    CAS  Article  Google Scholar 

  5. 5.

    Czuczman MS, Goy A, Lamonica D, Graf DA, Munteanu MC, Van der Jagt RH. Phase II study of bendamustine combined with rituximab in relapsed / refractory mantle cell lymphoma: efficacy, tolerability, and safety findings. Ann Hematol. 2015;94:2025–32.

    CAS  Article  Google Scholar 

  6. 6.

    Visco C, Finotto S, Zambello R, Paolini R, Menin A, Zanotti R, et al. Combination of rituximab, bendamustine, and cytarabine for patients with mantle-cell non-Hodgkin lymphoma ineligible for intensive regimens or autologous transplantation. J Clin Oncol. 2013;31:1442–9.

    CAS  Article  Google Scholar 

  7. 7.

    Rummel MJ, Niederle N, Maschmeyer G, Banat GA, Von Grünhagen U, Losem C, et al. Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet. 2013;381:1203–10.

    CAS  Article  Google Scholar 

  8. 8.

    Flinn IW, Van DerJagt R, Kahl BS, Wood P, Hawkins TE, Macdonald D, et al. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014;123:2944–52.

    CAS  Article  Google Scholar 

  9. 9.

    Visco C, Chiappella A, Nassi L, Patti C, Ferrero S, Barbero D, et al. Rituximab, bendamustine, and low-dose cytarabine as induction therapy in elderly patients with mantle cell lymphoma: a multicentre, phase 2 trial from Fondazione Italiana Linfomi. Lancet Haematol. 2017;4:e15–23.

    Article  Google Scholar 

  10. 10.

    Flinn IW, Van DerJagt R, Kahl B, Wood P, Hawkins T, Macdonald D. First-line treatment of patients with indolent non-Hodgkin lymphoma or mantle-cell lymphoma with bendamustine plus rituximab versus R-CHOP or R-CVP: Results of the bright 5-year follow-up study. J Clin Oncol. 2019;37:984–92.

    CAS  Article  Google Scholar 

  11. 11.

    Anderson C, Goldstone A, Souhami RL, Linch DC, Harper PG, McLennan KA, et al. Very high dose chemotherapy with autologous bone marrow rescue in adult patients with resistant relapsed lymphoma. Cancer Chemother Pharm. 1986;16:170–5.

    CAS  Article  Google Scholar 

  12. 12.

    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.

    CAS  Article  Google Scholar 

  13. 13.

    Damaj G, Cornillon J, Bouabdallah K, Gressin R, Vigouroux S, Gastinne T, et al. Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: a review. Bone Marrow Transplant. 2017;52:941–9.

    CAS  Article  Google Scholar 

  14. 14.

    Roué G, Lopez-Guerra M, Milpied P, Pérez-Galan P, Villamor N, Montserrat E, et al. Bendamustine is effective in p53-deficient B-cell neoplasms and requires oxidative stress and caspase-independent signaling. Clin Cancer Res. 2008;14:6907–16.

    Article  Google Scholar 

  15. 15.

    Visco C, Castegnaro S, Chieregato K, Bernardi M, Albiero E, Zanon C, et al. The cytotoxic effects of bendamustine in combination with cytarabine in mantle cell lymphoma cell lines. Blood Cells, Mol Dis. 2012;48:68–75.

    CAS  Article  Google Scholar 

  16. 16.

    Visani G, Malerba L, Stefani PM, Capria S, Galieni P, Gaudio F, et al. BeEAM (bendamustine, etoposide, cytarabine, melphalan) before autologous stem cell transplantation is safe and effective for resistant/relapsed lymphoma patients. Blood. 2011;118:3419–26.

    CAS  Article  Google Scholar 

  17. 17.

    Visani G, Stefani PM, Capria S, Malerba L, Galieni P, Gaudio F, et al. Bendamustine, etoposide, cytarabine, melphalan, and autologous stem cell rescue produce à 72% 3-years PFS in resistant lymphoma. Blood. 2014;124:3029–31.

    CAS  Article  Google Scholar 

  18. 18.

    Touzeau C, Leux C, Bouabdallah R, Roussel M, Delarue R, Bouabdallah K, et al. Autologous stem cell transplantation in mantle cell lymphoma: a report from the SFGM-TC. Ann Hematol. 2014;93:233–42.

    CAS  Article  Google Scholar 

  19. 19.

    Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, et al. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. J Clin Oncol. 1999;17:1244.

    CAS  Article  Google Scholar 

  20. 20.

    Chantepie SP, Garciaz S, Tchernonog E, Peyrade F, Larcher MV, Diouf M, et al. Bendamustine-based conditioning prior to autologous stem cell transplantation (ASCT): results of a French multicenter study of 474 patients from LYmphoma Study Association (LYSA) centers. Am J Hematol. 2018;93:729–35.

    CAS  Article  Google Scholar 

  21. 21.

    Scrucca L, Santucci A, Aversa F. Competing risk analysis using R: an easy guide for clinicians. Bone Marrow Transpl. 2007;40:381–7.

    CAS  Article  Google Scholar 

  22. 22.

    Scrucca L, Santucci A, Aversa F. Regression modeling of competing risk using R: an in depth guide for clinicians. Bone Marrow Transpl. 2010;45:1388–95.

    CAS  Article  Google Scholar 

  23. 23.

    Le Gouill S, Thieblemont C, Oberic L, Moreau A, Bouabdallah K, Dartigeas C, et al. Rituximab after autologous stem-cell transplantation in mantle-cell lymphoma. N. Engl J Med. 2017;377:1250–60.

    Article  Google Scholar 

  24. 24.

    Kluin-Nelemans HC, Hoster E, Hermine O, Walewski J, Trneny M, Geisler CH, et al. Treatment of older patients with mantle-cell lymphoma. N. Engl J Med. 2012;367:520–31.

    CAS  Article  Google Scholar 

  25. 25.

    Rummel MJ, Knauf W, Goerner M, Soeling U, Lange E, Hertenstein B, et al. Two years rituximab maintenance vs. observation after first-line treatment with bendamustine plus rituximab (B-R) in patients with mantle cell lymphoma: First results of a prospective, randomized, multicenter phase II study (a subgroup study of the StiL NHL7-2008 MAINTAIN Trial). J. Clin. Oncol. 2016;34:(15_suppl)7503.

    Article  Google Scholar 

  26. 26.

    Wang ML, Rule S, Martin P, Goy A, Auer R, Kahl BS, et al. Targeting BTK with ibrutinib in relapsed or refractory mantle-cell lymphoma. N. Engl J Med. 2013;369:507–16.

    CAS  Article  Google Scholar 

  27. 27.

    Redondo AM, Valcárcel D, González-Rodríguez AP, Suárez-Lledó M, Bello JL, Canales M, et al. Bendamustine as part of conditioning of autologous stem cell transplantation in patients with aggressive lymphoma: a phase 2 study from the GELTAMO group. Br J Haematol. 2019;184:797–807.

    CAS  PubMed  Google Scholar 

  28. 28.

    Gilli S, Novak U, Taleghani BM, Baerlocher GM, Leibundgut K, Banz Y, et al. BeEAM conditioning with bendamustine-replacing BCNU before autologous transplantation is safe and effective in lymphoma patients. Ann Hematol. 2017;96:421–9.

    CAS  Article  Google Scholar 

  29. 29.

    Noesslinger T, Panny M, Simanek R, Moestl M, Boehm A, Menschel E, et al. High-dose Bendamustine-EAM followed by autologous stem cell rescue results in long-term remission rates in lymphoma patients, without renal toxicity. Eur J Haematol. 2018;101:326–31.

    CAS  Article  Google Scholar 

  30. 30.

    Prediletto I, Farag SA, Bacher U, Jeker B, Mansouri Taleghani B, Brégy R, et al. High incidence of reversible renal toxicity of dose-intensified bendamustine-based high-dose chemotherapy in lymphoma and myeloma patients. Bone Marrow Transplant. 2019;54:1923–25.

    Article  Google Scholar 

  31. 31.

    Saleh K, Danu A, Koscielny S, Legoupil C, Pilorge S, Castilla-llorente C, et al. A retrospective, matched paired analysis comparing bendamustine containing BeEAM versus BEAM conditioning regimen: results from a single center experience. Leuk Lymphoma. 2018;59:2580–7.

    CAS  Article  Google Scholar 

  32. 32.

    Jo JC, Kang BW, Jang G, Sym SJ, Lee SS, Koo JE, et al. BEAC or BEAM high-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin’ s lymphoma patients: comparative analysis of efficacy and toxicity. Ann Hematol. 2008;87:43–8.

    CAS  Article  Google Scholar 

  33. 33.

    Olivieri J, Mosna F, Pelosini M, Fama A, Rattotti S, Giannoccaro M, et al. A comparison of the conditioning regimens BEAM and FEAM for autologous hematopoietic stem cell transplantation in lymphoma: an observational study on 1038 patients from fondazione Italiana Linfomi. Biol Blood Marrow Transplant. 2018;24:1814–22.

    Article  Google Scholar 

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TH and GD designed and wrote the paper. TH and RM performed all statistical analyses. All authors reviewed and approved the paper.

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Correspondence to Gandhi Damaj.

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Hueso, T., Gastinne, T., Garciaz, S. et al. Bendamustine-EAM versus BEAM regimen in patients with mantle cell lymphoma undergoing autologous stem cell transplantation in the frontline setting: a multicenter retrospective study from Lymphoma Study Association (LYSA) centers. Bone Marrow Transplant 55, 1076–1084 (2020).

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