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Almothaffar AJ, Abdhlkadhum M, Shubbar M, Yousif F, Albakri Z. The outcome of relapsed/refractory hodgkin's lymphoma patients post autologous bone marrow transplantation in a Baghdad Medical City Complex Center. IRAQI JOURNAL OF HEMATOLOGY 2021. [DOI: 10.4103/ijh.ijh_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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2
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Jain R, Hans R, Totadri S, Trehan A, Sharma RR, Menon P, Kapoor R, Saxena AK, Mittal BR, Bhatia P, Kakkar N, Srinivasan R, Rajwanshi A, Varma N, Samujh R, Marwaha N, Bansal D. Autologous stem cell transplant for high-risk neuroblastoma: Achieving cure with low-cost adaptations. Pediatr Blood Cancer 2020; 67:e28273. [PMID: 32196923 DOI: 10.1002/pbc.28273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/16/2020] [Accepted: 03/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The majority of patients in low- and middle-income countries (LMIC) are unable to receive optimal therapy, including autologous stem cell transplant (ASCT) for high-risk neuroblastoma. Management is intensive and multidisciplinary; survival is often poor. We report a single-center outcome of high-risk neuroblastoma, with adaptations optimized for LMIC. PROCEDURE The study was retrospective. Patients were treated on the backbone of the high-risk neuroblastoma study-1 of SIOP-Europe (HR-NBL1/SIOPEN) protocol with ASCT. Adaptations incorporated to decrease cost, requirement for inpatient admission, infections, and faster engraftment included (a) optional outpatient administration for rapid-COJEC, (b) two sessions of stem-cell apheresis, (c) storing stem cells at 2-6°C without cryopreservation for up to 7 days, (d) no central lines, (e) no antibacterial/antifungal/antiviral prophylaxis, (f) omitting formal assessment of cardiac/renal/pulmonary functions before ASCT, and (g) administration of pegylated granulocyte colony-stimulating factor on Day +4. RESULTS Over 5 years 9 months, 35 patients with high-risk neuroblastoma were treated. Rapid-COJEC was administered over a median duration of 80 days (interquartile range: 77, 83). Conditioning regimen included melphalan (n = 7), oral busulfan-melphalan (Bu/Mel; n = 6), or intravenous Bu/Mel (n = 22). The median viability of stem cells stored for 6 days (n = 28) was 93% (range: 88-99). Two (5.7%) patients had ASCT-related mortality. The 3-year overall and event-free survival was 41% and 39%, respectively. A relapse occurred in 20 (57%) patients. Treatment abandonment was observed in one (3%) patient. CONCLUSIONS Administration of therapy in a disciplined time frame along with low-cost adaptations enables to manage high-risk neuroblastoma with low abandonment and an encouraging survival in LMIC. Stem cells can be stored safely without cryopreservation for up to 7 days.
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Affiliation(s)
- Richa Jain
- Department of Pediatrics, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
| | - Rekha Hans
- Department of Transfusion, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sidharth Totadri
- Department of Pediatrics, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Kumar Saxena
- Departement of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prateek Bhatia
- Department of Pediatrics, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Marwaha
- Department of Transfusion, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
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Colita A, Colita A, Bumbea H, Croitoru A, Orban C, Lipan LE, Craciun OG, Soare D, Ghimici C, Manolache R, Gelatu I, Vladareanu AM, Pasca S, Teodorescu P, Dima D, Lupu A, Coriu D, Tomuleasa C, Tanase A. LEAM vs. BEAM vs. CLV Conditioning Regimen for Autologous Stem Cell Transplantation in Malignant Lymphomas. Retrospective Comparison of Toxicity and Efficacy on 222 Patients in the First 100 Days After Transplant, On Behalf of the Romanian Society for Bone Marrow Transplantation. Front Oncol 2019; 9:892. [PMID: 31552193 PMCID: PMC6746965 DOI: 10.3389/fonc.2019.00892] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
High-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplantation (ASCT) is widely used in patients with malignant lymphomas. In Europe over 8,000 ASCTs for lymphoma were performed out of a total of 40,000 transplants according to the European Bone Marrow Transplant (EBMT) activity survey in 2017. ASCT is considered the standard treatment for eligible patients failing to achieve remission after first line chemotherapy or patients with relapsed or refractory lymphomas, including classical Hodkin's lymphoma, diffuse large B-cell lymphoma, mantle cell lymphoma, and follicular lymphoma, as well as consolidation therapy in first remission in mantle cell lymphoma. BEAM (BCNU/carmustine, etoposide, cytarabine, and melphalan) is the most commonly used conditioning regimen for ASCT in patients with relapsed/refractory (R/R) lymphomas in Europe, whereas the CBV (cyclophosphamide, BCNU, and etoposide) regimen is also widely used in North America. Recently, concerns regarding BCNU toxicity as well as restricted availability of BCNU and melphalan has determined an increasing number of transplant centers to use alternative conditioning regimens. Currently, only a few comparative studies, most of them retrospective, between different conditioning protocols regarding efficacy and toxicity have been published. Thus, in the current manuscript, we report the experience of 2 transplant centers in ASCT in R/R lymphomas with three types of conditioning: BEAM, CLV (cyclophosphamide, lomustine, etoposide) and LEAM (lomustine, etoposide, cytarabine, and melphalan), with the aim to evaluate the results of alternative conditioning regimens using lomustine (LEAM and CLV) and compare them with the standard BEAM regarding early toxicity, engraftment, and transplant related mortality (TRM). All patients developed grade IV neutropenia, anemia with/without transfusion necessity. Severe thrombocytopenia with transfusion requirements is reported in most cases. Median time to platelet engraftment and neutrophil engraftment was 13 days (range) and 10 days (range), respectively. Gastrointestinal toxicity was the most common non-hematologic toxicity after all three conditioning regimens. Oral mucositis in various grades from I to IV was diagnosed in most cases. Other side effects include vomiting, diarrhea, colitis, and skin rash but with low severity grades. For the LEAM arm, one patient died after transplant, before engrafting, one patient didn't achieve platelet engraftment in day 100, one patient developed grade 3 upper gastrointestinal bleeding, one patient died (grade 5 toxicity) with acute renal failure, one patient developed hypoxic events up to grade 4 acute respiratory failure and one patient developed grade 3 itchy skin rash. For the CLV arm, one patient died after transplant, before engrafting, one patient developed grade 3 colitis, one patient with grade 3 hepatic cytolysis, one patient with cardiac toxicity followed by death (grade 5) caused by an acute myocardial infarction with ST elevation and one patient with pulmonary toxicity clinically manifested with grade 3 pleurisy. For the BEAM arm, one patient developed grade 3 cardiac toxicity with sinus bradycardia and afterwards grade 4 with acute pulmonary edema, three patients presented a grade 3 pruritic skin rash and two patients developed grade 3 seizures. In the present study we presented the differences that were observed between BEAM, LEAM, and CLV conditioning regimens offering clinical arguments for an SCT practitioner choice in the ideal situation, but also of choice for alternative regimens in the case that one regimen cannot be used.
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Affiliation(s)
- Andrei Colita
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Anca Colita
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Horia Bumbea
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, University Hospital, Bucharest, Romania
| | - Adina Croitoru
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Carmen Orban
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Lavinia Eugenia Lipan
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Oana-Gabriela Craciun
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Dan Soare
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, University Hospital, Bucharest, Romania
| | - Cecilia Ghimici
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Raluca Manolache
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Ionel Gelatu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Ana-Maria Vladareanu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sergiu Pasca
- Department of Hematology, Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Anca Lupu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Stem Cell Transplantation, Coltea Clinical Hospital, Bucharest, Romania
| | - Daniel Coriu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania
| | - Ciprian Tomuleasa
- Department of Hematology, Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Dos Santos KB, Costa LJM, Bettarello G, da Matta Abreu M, Mayrink GTC, Mota MA, Ribeiro LC, Pereira J, Hallack Neto AE. LEAM versus CBV for conditioning in autologous hematopoietic stem cell transplantation for lymphoma. Bone Marrow Transplant 2018; 54:625-628. [PMID: 30283147 DOI: 10.1038/s41409-018-0349-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 08/14/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Kelli Borges Dos Santos
- Hematology and Bone Marrow Transplantation Center of University Hospital, Federal University of Juiz de Fora, Rua Catulo Breviglieri, s/n, Bairro Santa Catarina, Juiz de Fora, Minas Gerais, 36036-110, Brazil.
| | - Luciano José Megale Costa
- Bone Marrow Transplantation and Cell Therapy Program of UAB-CCC, Alabama, Birmingham, 36036-110, USA
| | - Gustavo Bettarello
- Cardiology Institute of Distrito Federal, Brasilia, Distrito Federal, 36036-110, Brazil
| | - Marcus da Matta Abreu
- University Hospital, Federal University of Juiz de Fora, Rua Catulo Breviglieri, s/n, Bairro Santa Catarina, Juiz de Fora, Minas Gerais, 36036-110, Brazil
| | - Graziela Toledo Costa Mayrink
- Bone Marrow Transplantation Center of University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-110, Brazil
| | - Mariza Aparecida Mota
- Transfusion Agency of the University Hospital at the Federal University of Juiz de Fora, Rua Catulo Breviglieri, s/n, Bairro Santa Catarina, Juiz de Fora, Minas Gerais, 36036-110, Brazil
| | - Luiz Cláudio Ribeiro
- Department of Statistics of the Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-110, Brazil
| | - Juliana Pereira
- Laboratory of Immunopathology, Hematology Service, Cental Institute of Cancer of Hospital das Clínicas, FM-USP, São Paulo, Brazil
| | - Abrahão Elias Hallack Neto
- Bone Marrow Transplantation Center of University Hospital, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, 36036-110, Brazil
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Comparable safety profile of BeEAM (bendamustine, etoposide, cytarabine, melphalan) and BEAM (carmustine, etoposide, cytarabine, melphalan) as conditioning before autologous haematopoietic cell transplantation. Contemp Oncol (Pozn) 2018; 22:113-117. [PMID: 30150889 PMCID: PMC6103227 DOI: 10.5114/wo.2018.77046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/26/2018] [Indexed: 11/27/2022] Open
Abstract
Introduction BEAM (carmustine, etoposide, cytarabine, melphalan) is the most frequently used high-dose chemotherapy regimen for patients with lymphoma referred for autologous haematopoietic cell transplantation (autoHCT). Recently, a novel conditioning protocol containing bendamustine instead of carmustine (BeEAM) has been proposed to potentially increase the efficacy. Aim of the study The aim of this study was to retrospectively compare the safety profile of BEAM and BeEAM based on single-centre experience. Material and methods A total of 237 consecutive patients with lymphoma treated with either BEAM (n = 174) or BeEAM (n = 63), between the years 2011 and 2016, were included in the analysis. Clinical characteristics of both groups were comparable. Patients with Hodgkin’s lymphoma (HL) constituted 49% of the BEAM group and 40% of the BeEAM group. Results Median time to neutrophil > 0.5 × 109/l recovery was 10 days in both groups (p = 0.29), while median time to platelet > 50 × 109/l recovery was 13 and 14 days after BEAM and BeEAM, respectively (p = 0.12). The toxicity profile was comparable except for arterial hypertension and severe hypokalaemia, which occurred more frequently after BeEAM compared to BEAM (p = 0.02 and p = 0.004, respectively). The rate of early mortality was 1.7% and 1.6%, respectively. The probabilities of the overall and progression-free survival were comparable for both groups (p = 0.73 and p = 0.55, respectively). Conclusions Administration of bendamustine instead of carmustine as part of conditioning does not affect the engraftment or the toxicity profile of the regimen. Therefore, BeEAM may be safely used in patients with lymphoma undergoing autoHCT. Its efficacy requires evaluation in prospective studies.
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Abstract
PURPOSE OF REVIEW Chemotherapy remains the first-line therapy for aggressive lymphomas. However, 20-30% of patients with non-Hodgkin lymphoma (NHL) and 15% with Hodgkin lymphoma (HL) recur after initial therapy. We want to explore the role of high-dose chemotherapy (HDT) and autologous stem cell transplant (ASCT) for these patients. RECENT FINDINGS There is some utility of upfront consolidation for-high risk/high-grade B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma, but there is no role of similar intervention for HL. New conditioning regimens are being investigated which have demonstrated an improved safety profile without compromising the myeloablative efficiency for relapsed or refractory HL. Salvage chemotherapy followed by HDT and rescue autologous stem cell transplant remains the standard of care for relapsed/refractory lymphoma. The role of novel agents to improve disease-related parameters remains to be elucidated in frontline induction, disease salvage, and high-dose consolidation or in the maintenance setting.
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7
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Isidori A, Christofides A, Visani G. Novel regimens prior to autologous stem cell transplantation for the management of adults with relapsed/refractory non-Hodgkin lymphoma and Hodgkin lymphoma: alternatives to BEAM conditioning. Leuk Lymphoma 2016; 57:2499-509. [DOI: 10.1080/10428194.2016.1185785] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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A retrospective comparison of toxicity and initial efficacy of two autologous stem cell transplant conditioning regimens for relapsed lymphoma: LEAM and BEAM. Bone Marrow Transplant 2016; 51:1397-1399. [DOI: 10.1038/bmt.2016.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Isidori A, Clissa C, Loscocco F, Guiducci B, Barulli S, Malerba L, Gabucci E, Visani G. Advancement in high dose therapy and autologous stem cell rescue in lymphoma. World J Stem Cells 2015; 7:1039-1046. [PMID: 26328019 PMCID: PMC4550627 DOI: 10.4252/wjsc.v7.i7.1039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/27/2015] [Accepted: 07/17/2015] [Indexed: 02/06/2023] Open
Abstract
Although advanced stage aggressive non-Hodgkin’s lymphomas and Hodgkin’s disease are thought to be chemotherapy-responsive cancers, a considerable number of patients either relapse or never attain a remission. High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) is often the only possibility of cure for most of these patients. However, many controversial issues still remain with respect to HDT/ASCT for lymphomas, including its role for, the optimal timing of transplantation, the best conditioning regimen and the potential use of localized radiotherapy or immunologic methods to decrease post-transplant recurrence. Recently, mainly due to the unavailability of carmustine, several novel conditioning protocols have been clinically developed, with the aim of improving the overall outcome by enhancing the anti-lymphoma effect and, at the same time, by reducing short and long-term toxicity. Furthermore, the better safety profiles of novel approaches would definitively allow patients aged more than 65-70 years to benefit from this therapeutic option. In this review, we will briefly discuss the most relevant and recent data available regarding HDT/ASCT in lymphomas.
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dos Santos KB, Costa LJ, Atalla A, Pereira J, Hallack-Neto AE. Lomustine use in combination with etoposide, cytarabine and melphalan in a brief conditioning regimen for auto-HSCT in patients with lymphoma: the optimal dose. Bone Marrow Transplant 2014; 49:1239-40. [PMID: 24887380 DOI: 10.1038/bmt.2014.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- K B dos Santos
- Universidade Federal de Juiz de Fora, Division of Hematology and Bone Marrow Transplantation, Minas Gerais, Brazil
| | - L J Costa
- Medical University of South Carolina, Division of Hematology/Oncology, Charleston, SC, USA
| | - A Atalla
- Universidade Federal de Juiz de Fora, Division of Clinical Medical, Minas Gerais, Brazil
| | - J Pereira
- Universidade Federal de São Paulo, Division of Hematology, São Paulo, Brazil
| | - A E Hallack-Neto
- Universidade Federal de Juiz de Fora, Division of Clinical Medical, Minas Gerais, Brazil
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Kayal S, Sharma A, Iqbal S, Tejomurtula T, Cyriac SL, Raina V. High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Multiple Myeloma: A Single Institution Experience at All India Institute of Medical Sciences, New Delhi, Using Non-Cryopreserved Peripheral Blood Stem Cells. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:140-7. [DOI: 10.1016/j.clml.2013.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 09/18/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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Musso M, Porretto F, Scalone R, Crescimanno A, Polizzi V, Bonanno V. Novel conditioning regimens for Hodgkin’s and non-Hodgkin’s lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.13.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Autologous stem cell transplantation (ASCT), in chemosensitive relapsed patients with Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL), is associated with superior event-free survival (EFS) compared with salvage chemotherapy alone. BEAM is one of the most commonly used regimens in both HL and NHL because of its acceptable toxicity and high effectiveness. The nonrelapsed mortality (NRM) ranges from 7 to 10% in historical studies. More recent investigations have demonstrated a lower NRM, probably due to various factors such as the use of peripheral blood precursor cells and better support therapy. Recently, in order to reduce the toxicity of carmustine and increase antilymphoma activity, several groups have introduced conditioning regimens similar to BEAM. The incorporation of newer drugs (anti-CD20 monoclonal antibodies ± radiolabeled) to ‘classic’ BEAM, or the substitution of carmustine with other drugs (thiotepa, bendamustine and fotemustine) may be a valuable strategy in this patient setting. In this review, we will discuss the data available on HDC followed by ASCT in lymphoma using new conditioning regimens, namely second-generation BEAM.
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Affiliation(s)
- Maurizio Musso
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Ferdinando Porretto
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Renato Scalone
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Alessandra Crescimanno
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Vita Polizzi
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
| | - Vincenza Bonanno
- UO Oncoematologia e trapianto di midollo osseo, Dipartimento Oncologico, La Maddalena, Via S. lorenzo Colli no. 312 D, 90146 Palermo, Italy
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13
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Sharma A, Kayal S, Iqbal S, Malik PS, Raina V. Comparison of BEAM vs. LEAM regimen in autologous transplant for lymphoma at AIIMS. SPRINGERPLUS 2013; 2:489. [PMID: 25674395 PMCID: PMC4320155 DOI: 10.1186/2193-1801-2-489] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
Abstract
BEAM (BCNU, etoposide, cytrabine, melphalan) is the most widely used high dose chemotherapy regimen for autologous transplant in lymphoid malignancies. We report our early experience with an alternative regimen LEAM where BCNU was replaced with the oral analogue CCNU (lomustine) to tide over the non-availability of BCNU. Fifty one patients of relapsed or refractory lymphoma who received BEAM (n= 34) and LEAM (n= 17) from September 2001 to February 2012 were analyzed. From October 2009 onwards LEAM was used as the conditioning regimen instead of conventional BEAM. Patients in the LEAM group had more chemorefractory disease (35% vs 9%, p = 0.045) and high risk comorbidity score (24% vs 0%, p = 0.019). Grade 3 and 4 oral mucositis (67.6% vs. 64.7%, p = 0.834) and diarrhea (47% vs. 41.1%, p = 0.691) were similar. No difference was noted between the two groups in terms of engraftment, documented infections, antibiotic use, cumulative toxicity risk, length of hospital stay and 100 day transplant related mortality. The estimated 2 year overall survival (61.7% vs. 62.7%, p = 0.928) and event free survival (44.6% vs. 41.1%, p = 0.510) of the regimens BEAM and LEAM respectively were comparable. Thus LEAM appeared equivalent to BEAM in terms of toxicity and efficacy and can be used as an alternative to BEAM.
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Affiliation(s)
- Atul Sharma
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Kayal
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sobuhi Iqbal
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Moscato T, Fedele R, Messina G, Irrera G, Console G, Martino M. Hematopoietic progenitor cells transplantation for recurrent or refractory Hodgkin's lymphoma. Expert Opin Biol Ther 2013; 13:1013-27. [PMID: 23586758 DOI: 10.1517/14712598.2013.779250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Advanced-stage Hodgkin's lymphoma (HL) has become a curable disease in the majority of patients. Despite this, about 20% of these patients relapsed or are primary refractory to the first-line treatment and high-dose chemotherapy (HDC) and autologous (Auto) hematopoietic progenitor cells transplantation (HPCT) are considered a therapeutic option. AREAS COVERED The authors reviewed HDC and HPCT treatment strategies in recurrent or refractory HL patients, with the goal of providing an overview of this approach. EXPERT OPINION Patients younger than 60-65 years with relapsed disease or refractory to first-line therapy should receive a second-line chemotherapy, followed by HDC and Auto-HPCT. Progression-free and overall survival results are significantly better when a second remission or a minimal disease status is achieved before Auto-HPCT, and demonstrate that this strategy is able to cure more than half of the advanced HL patients. Myeloablative allogeneic HPCT (Allo-HPCT) has been employed in advanced phases of the disease, but there have been significant concerns due to treatment-related mortality (TRM). The safety of allogeneic transplantation has improved with the use of reduced-intensity allogeneic (RIC-Allo) HPCT strategies. Despite early favorable results, mature results of RIC-Allo available in the literature are consistent in demonstrating a lack of long-term disease control.
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Affiliation(s)
- Tiziana Moscato
- Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera BMM, Via Melacrino n.1, 89100 Reggio Calabria, Italy.
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Hallack Neto AE, Borges dos Santos K, Atalla A. Modified BEAM conditioning regimen in patients with Hodgkin and non-Hodgkin lymphomas. EXP CLIN TRANSPLANT 2012; 10:622. [PMID: 23216569 DOI: 10.6002/ect.2012.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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