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Wang R, Shangguan X, Zhu Z, Cong D, Bai Y, Zhang W. BeEAM vs. BEAM: evaluating conditioning regimens for autologous stem cell transplantation in patients with relapsed or refractory DLBCL. Ann Hematol 2024; 103:2455-2462. [PMID: 38809456 DOI: 10.1007/s00277-024-05813-w] [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: 02/18/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To evaluate whether BeEAM is an alternative to BEAM for autologous stem cell transplantation (ASCT) in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). METHODS Data of 60 patients with relapsed or refractory DLBCL who underwent ASCT from January 2018 to June 2023 in our center, including 30 patients in the BeEAM group and 30 patients in the BEAM group, were retrospectively analyzed. The time to hematopoietic reconstitution, treatment-related adverse events, number of hospitalization days, hospitalization cost, and survival benefit were compared between the two groups. RESULTS The clinical characteristics of the patients did not significantly differ between the two groups. The median number of reinfused CD34 + cells was 5.06 × 106/kg and 5.17 × 106/kg in the BeEAM and BEAM groups, respectively, which did not significantly different (p = 0.8829). In the BeEAM and BEAM groups, the median time to neutrophil implantation was 10.2 and 10.27 days, respectively (p = 0.8253), and the median time to platelet implantation was 13.23 and 12.87 days, respectively (p = 0.7671). In the BeEAM and BEAM groups, the median hospitalization duration was 30.37 and 30.57 days, respectively (p = 0.9060), and the median hospitalization cost was RMB 83,425 and RMB 96,235, respectively (p = 0.0560). The hospitalization cost was lower in the BeEAM group. The most common hematologic adverse events were grade ≥ 3 neutropenia and thrombocytopenia, whose incidences were similar in the two groups. The most common non-hematologic adverse events were ≤ grade 2 and the incidences of these events did not significantly differ between the two groups. Median overall survival was not reached in either group, with predicted 5-year overall survival of 72.5% and 60% in the BeEAM and BEAM groups, respectively (p = 0.5872). Five-year progression-free survival was 25% and 20% in the BeEAM and BEAM groups, respectively (p = 0.6804). CONCLUSION As a conditioning regimen for relapsed or refractory DLBCL, BeEAM has a desirable safety profile and is well tolerated, and its hematopoietic reconstitution time, number of hospitalization days, and survival benefit are not inferior to those of BEAM. BeEAM has a lower hospitalization cost and is an alternative to BEAM.
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Affiliation(s)
- Ruiqi Wang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Xinghe Shangguan
- Department of Hematology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116021, China
| | - Zhenxing Zhu
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Dan Cong
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Yuansong Bai
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Wenlong Zhang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China.
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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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Costes-Tertrais D, Hueso T, Gastinne T, Thieblemont C, Oberic L, Bouabdallah K, Garciaz S, Tchernonog E, Dartigeas C, Ribrag V, Fogarty P, Casasnovas RO, Houot R, Delette C, Malak S, Fornecker LM, Gressin R, Damaj G, Le Gouill S. Bendamustine-EAM versus R-BEAM after high-dose cytarabine-based induction in newly diagnosed patients with mantle cell lymphoma, a LYSA retrospective study. Bone Marrow Transplant 2022; 57:627-632. [PMID: 35149851 DOI: 10.1038/s41409-022-01596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
Abstract
Cytarabine-based immuno-chemotherapy followed by autologous stem cell transplantation (ASCT) consolidation is standard of care for fit patients with Mantle Cell Lymphoma (MCL). BEAM (Carmustine, Etoposide, Aracytine, Melphalan) is among the most frequently used conditioning regimen. Studies comparing BEAM with Bendamustine-EAM (BeEAM) have suggested that patients treated with BeEAM have a better progression-free survival (PFS). We performed a cross-study analysis to better evaluate BeEAM. Thirty-five patients from a retrospective study who received R-DHAP/BeEAM were compared to 245 patients from the LyMa trial (NCT00921414) who all received R-DHAP followed by R-BEAM. PFS and Overall Survival (OS) were estimated using Kaplan-Meier methods. At 2 years there was no difference between R-BEAM and BeEAM in either PFS (84.9% versus 87.9%; p = 0.95) or OS (91.8% versus 94.2%; p = 0.30). Analyses were repeated on a propensity score to reduce biases. Each patient from the BeEAM cohort (n = 30) was matched to three patients from the R-BEAM cohort (n = 90) for age, sex, MIPI score, pre-transplant status disease and rituximab maintenance (RM). PFS and OS at 2 years remained similar between R-BEAM and BeEAM with more renal toxicity in BeEAM group. MCL patients who received R-DHAP induction before ASCT have similar outcome after R-BEAM or BeEAM conditioning regimen.
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Affiliation(s)
- Domitille Costes-Tertrais
- Department of Hematology, CHU de Nantes, University Hospital of Nantes, Nantes, France.,School of Medicine, Nantes University, Nantes, France
| | - Thomas Hueso
- Department of Hematology, APHP-Avicenne Hospital, Paris, France.,Sorbonne University Paris Nord, Bobigny, France
| | - Thomas Gastinne
- Department of Hematology, CHU de Nantes, University Hospital of Nantes, Nantes, France
| | - Catherine Thieblemont
- Department of Hemato-oncology, APHP-Saint-Louis Hospital, Paris, France.,Diderot Sorbonne Paris-Cité University, Paris, France.,Descartes University, Paris, France
| | - Lucie Oberic
- Department of Clinical Hematology, Toulouse Oncopole, Toulouse, France
| | - Krimo Bouabdallah
- Department of Clinical Hematology, Bordeaux University Hospital, Bordeaux, France
| | - Sylvain Garciaz
- Department of Clinical Hematology, Paoli Calmettes Institute, Marseille, France
| | - Emmanuelle Tchernonog
- Department of Clinical Hematology, Montpellier University Hospital, Montpellier, France
| | - Caroline Dartigeas
- Department of Clinical Hematology, Tours University Hospital, Tours, France
| | | | | | - René-Olivier Casasnovas
- Department of Clinical Hematology, François Mitterrand University Hospital, Dijon, France.,Inserm UMR 1231, Dijon, France
| | - Roch Houot
- Department of Clinical Hematology, Rennes University Hospital, F-35033, Rennes, France.,MICMAC-Inserm UMR 1236, Rennes University, F-35000, Rennes, France
| | - Caroline Delette
- Department of Clinical Hematology, Amiens University Hospital, Amiens, France
| | - Sandra Malak
- Department of Clinical Hematology, Curie Institute, René Huguenin Hospital, Saint-Cloud, France
| | | | - Remy Gressin
- Department of Clinical Hematology, Grenoble University Hospital, Grenoble, France
| | - Gandhi Damaj
- Department of Clinical Hematology, Caen University Hospital, F-14000, Caen, France.,School of Medicine, Normandy University, F-14000, Caen, France
| | - Steven Le Gouill
- Department of Hematology, CHU de Nantes, University Hospital of Nantes, Nantes, France. .,Now at Curie Insitute, Paris, France.
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