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Keil F, Müller AM, Berghold A, Riedl R, Buxhofer-Ausch V, Schuster J, Vorburger C, Böhm A, Panny M, Nösslinger T, Greil R, Samaras P, Bencker C, Rütti M, Pabst T. BendaEAM versus BEAM as conditioning regimen for ASCT in patients with relapsed lymphoma (BEB): a multicentre, randomised, phase 2 trial. EClinicalMedicine 2023; 66:102318. [PMID: 38024477 PMCID: PMC10679477 DOI: 10.1016/j.eclinm.2023.102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Replacement of carmustine (BCNU) in the BEAM regimen (BCNU, etoposide, cytarabine, melphalan) with bendamustine (BendaEAM) before autologous stem cell transplantation (ASCT) is feasible in lymphoma. However, randomised trials are lacking. Here, we present the first trial addressing this topic. Methods This multicentre, randomised, phase 2 study (BEB-trial) conducted at four haematological centres in Austria and Switzerland compares BEAM with BendaEAM in patients with relapsed lymphoma. Both regimens were administered intravenously before ASCT, in BEAM according to the standard protocol (300 mg/m2 BCNU on day -6), in BendaEAM, BCNU was replaced by 200 mg/m2 bendamustine given on days -7 and -6. Eligible patients were aged 18-75 years and had mantle cell lymphoma, diffuse large B-cell lymphoma, or follicular lymphoma in first or second remission or chemosensitive relapse. The primary endpoint of the study was to evaluate whether replacement of BCNU by bendamustine reduces lung toxicity, defined as a decrease of the diffusion capacity of the lung for carbon monoxide by at least 20% at three months after ASCT. Data analyses were performed on an intention-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT02278796, and is complete. Findings Between April 20, 2015, and November 28, 2018, 108 patients were enrolled; of whom 53 were randomly assigned to receive BendaEAM (36 male, 17 female) and 55 to receive BEAM (39 male, 16 female). All patients engrafted rapidly. Lung toxicity did not differ between groups (BendaEAM: n = 8, 19.5%; BEAM: n = 11, 25.6%; risk difference = -6.1%: 95% confidence interval: -23.9% to 11.7%). Acute toxicities of at least grade 3 were comparable in both groups (BendaEAM: 35.8%, BEAM: 30.9%). Overall survival (BendaEAM: 92.5%, BEAM: 89.1%) and complete remission (BendaEAM: 76.7%, BEAM: 74.3%) after 1 year (median follow-up: 369 days) were similar. No difference in quality of life was observed. Interpretation Results were similar for both regimens in terms of survival and response rates. A phase 3 non-inferiority study is required to investigate whether BendaEAM can be considered as an alternative to BEAM. Funding Mundipharma.
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Affiliation(s)
- Felix Keil
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Antonia M.S. Müller
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
- Department of Medical Oncology and Haematology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics, and Documentation, Medical University Graz, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics, and Documentation, Medical University Graz, Graz, Austria
| | - Veronika Buxhofer-Ausch
- Department of Internal Medicine I with Haematology, Stem Cell Transplantation, Haemostaseology and Medical Oncology, Ordensklinikum Linz Elisabethinen, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Judith Schuster
- Austrian Group Medical Tumor Therapy (AGMT), Salzburg, Austria
| | - Corinne Vorburger
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Alexandra Böhm
- Haematological Health Care Centre of the ÖGK Mariahilf, Vienna, Austria
| | - Michael Panny
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Thomas Nösslinger
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Richard Greil
- Austrian Group Medical Tumor Therapy (AGMT), Salzburg, Austria
- Cancer Cluster Salzburg (CCS), Salzburg, Austria
- III Medical Department with Haematology and Medical Oncology, Haemostaseology, Rheumatology and Infectious Diseases, Oncologic Centre, Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Centre for Clinical Cancer and Immunology Trials (CCCIT), Salzburg, Austria
| | - Panagiotis Samaras
- Clinic for Haematology and Oncology Hirslanden Zurich, Zurich, Switzerland
| | - Celine Bencker
- 3rd Medical Department for Haematology and Oncology, Hanusch Hospital, Vienna, Austria
| | - Markus Rütti
- Department of Medical Oncology and Haematology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Plante MÉ, Feng X, Boudreault JS. Single-center retrospective study assessing the efficacy and safety of BeEAM (bendamustine, etoposide, cytarabine, melphalan) as conditioning regimen for autologous hematopoietic stem cell transplantation. Leuk Lymphoma 2023; 64:1234-1242. [PMID: 37154396 DOI: 10.1080/10428194.2023.2203790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/01/2023] [Accepted: 04/09/2023] [Indexed: 05/10/2023]
Abstract
One of the most widely accepted conditioning regimens for hematopoietic stem cell transplantation (HSCT) is BEAM (carmustine, etoposide, cytarabine, melphalan). However, a recent increase in the cost of carmustine has limited its use bringing our institution to replace carmustine with bendamustine. This observational retrospective single-center study aims to report the efficacy and safety of the BeEAM regimen. 55 patients with diffuse large B-cell lymphoma (47%), Hodgkin lymphoma (25%), mantle cell lymphoma (25%), or follicular lymphoma (2%) were included. Progression-free survival (PFS) at 24 months was 75% and overall survival (OS) was 83%. Treatment-related mortality was 4%. The most common adverse effects were febrile neutropenia (98%), mucositis (72%) and colitis (60%). Our study demonstrated excellent efficacy of the BeEAM regimen. However, the toxicity profile of BeEAM significantly varies from one study to another, and guidelines suggesting optimal dose of bendamustine and supportive care are currently lacking.
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Affiliation(s)
- Marie-Élaine Plante
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada
| | - Xue Feng
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada
| | - Jean-Samuel Boudreault
- Division of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Canada
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Brooks TR, Jagadeesh D. Conditioning regimens: balancing efficacy and toxicity. Leuk Lymphoma 2023; 64:1223-1224. [PMID: 37501586 DOI: 10.1080/10428194.2023.2239970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Taylor R Brooks
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
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Wu R, Ma L. BeEAM (Bendamustine, Etoposide, Cytarabine, Melphalan) Versus BEAM (Carmustine, Etoposide, Cytarabine, Melphalan) as Conditioning Regimen Before Autologous Haematopoietic Cell Transplantation: A Systematic Review and Meta-Analysis. Cell Transplant 2023; 32:9636897231179364. [PMID: 37350429 PMCID: PMC10291416 DOI: 10.1177/09636897231179364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard of care for selected patients with refractory/relapsed Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL), and it is also used as first-line clinical consolidation option for some aggressive NHL subtypes. Conditioning regimen prior to ASCT is one of the essential factors related with clinical outcomes post transplant. The conditioning regimen of carmustine, etoposide, cytarabine, and melphalan (BEAM) traditionally is considered the standard of care for patients with lymphoma who are eligible for transplantation. Replacement of carmustine with bendamustine (BeEAM) was described as an alternative conditioning regimen in the autograft setting for patients with lymphoma. Several studies have reported inconsistent clinical outcomes comparing BeEAM and BEAM. Therefore, in the lack of well-designed prospective comparative studies, the comparison of BeEAM versus BEAM is based on retrospective trials. To compare the clinical outcomes between BeEAM and BEAM, we performed a meta-analysis of 10 studies which compared the outcomes between BeEAM and BEAM in patients autografted for lymphoma disease (HL or NHL). We searched article titles and compared transplantation with BeEAM versus BEAM in MEDLINE (PubMed), Cochrane library, and EMBASE database. Here, we report the results of nine main endpoints in our meta-analysis comparing BeEAM and BEAM, including neutrophil engraftment (NE), platelet engraftment (PE), overall survival (OS), progression free survival (PFS), non-relapse mortality (NRM), relapse rate (RR), grade 3 mucositis, renal toxicity, and cardiotoxicity. We discovered that the BeEAM regimen was associated with a slightly better PFS [pooled odds ratio (OR) of 0.70, 95% confidence interval (CI), 0.52-0.94, P = 0.02], lower RR (0.49, 95% CI, 0.31-0.76, P = 0.002), higher mucositis (3.43, 95% CI, 2.29-5.16, P = 0.001), renal toxicity (4.49, 95% CI, 2.68-7.51, P = 0.001), and cardiotoxicity (1.88, 95% CI, 1.03-3.40, P = 0.03). We also discovered that the two groups had equivalent NE (pooled WMD -0.64, 95% CI, -1.46 to 0.18, P = 0.13), PE (pooled WMD -0.3, 95% CI, -1.68 to 2.28, P = 0.77), OS (0.73, 95% CI, 0.52-1.01, P = 0.07), and NRM (1.51, 95% CI, 0.76-2.98, P = 0.24). The results of this meta-analysis show that the BeEAM regimen is a viable alternative to BEAM. More prospective comparisons between BeEAM and BEAM are required.
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Affiliation(s)
- Ran Wu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liyuan Ma
- Department of Hematology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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