Contributions
Abstract: PB2428
Type: Publication Only
Background
High-dose chemotherapy (HDC) followed by autologous stem cell transplantation (auto-SCT) is superior to conventional chemotherapy in a subgroup of newly diagnosed and relapsed/refractory lymphomas. And BEAM (semustine, etoposide, cytarabine, and melphalan) is one of the most commonly used conditioning regimens. However, the source of melphalan is restricted in China. The conditioning regimen of modified BuCy (busulfan, cyclophosphamide, semustine and cytarabine, mBuCy) has been widely used as the myeloablative regimen for AML and is well tolerated and has shown good efficacy. However, there are limited datum on the efficacy and safety of the mBuCy conditioning regimen in lymphoma auto-SCT. And whether this mBuCy conditioning regimen can be safely used as an alternative to BEAM in lymphoma was uncertain.
Aims
To evaluate the efficacy and toxicity of mBuCy and BEAM regimens.
Methods
From February 2014 to November 2017, a total of 70 Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) patients underwent HDC with mBuCy (n=27) or BEAM (n=43), followed by auto-SCT in our center. As far as the patient's disease status at time of auto-SCT is concerned, we made a 1:1 match. In total, 27 pairs of patients were analyzed.
Results
In our study, we found that there were no significant differences in median number of infused CD34+ cells/kg, hospitalization duration, and median units of transfused red blood cells and platelets, as well as the time of platelet engraftment between the two groups. However, neutrophil engraftment was somewhat faster in mBuCy group than that in the BEAM group (median days: 9 days vs 9.5 days, p=0.038). When it comes to toxicity, the incidence of nausea/vomiting, hepatic impairment, renal impairment, pulmonary infection and treatment-related mortality was found to be similar in the two groups. However, compared with patients conditioned with mBuCy, patients conditioned with BEAM were more likely to develop mucositis and diarrhea (p=0.029; p=0.040). For grade III-IV mucositis and diarrhea, the incidence rate was higher in BEAM (25.9% vs 3.7%; 18.5% vs 0%). With a median follow-up of 15.2 months (range, 3.0 - 41.3 months) in the mBuCy group and 34.9 months (range, 4.6 - 48.0 months) in the BEAM group, we compared the 2-year PFS (72.0% vs 72.0%, p=0.761) and 2-year OS (84.0% vs 77.0%, p=0.783) of the regimens mBuCy and BEAM respectively, which indicated that the two groups were equivalent. Univariate analysis revealed that the International Prognostic Index (IPI) at diagnosis (p=0.046) and the level of serum LDH at transplantation (p=0.002) were the variables associated with PFS. For OS, only the level of serum LDH at transplantation (p=0.010) remained significant. In multivariate analysis, only the level of serum LDH was significantly associated with PFS (p= 0.029, HR: 4.52; 95% CI: 1.17-17.56).
Conclusion
Conditioning regimen of mBuCy was found to be well tolerated with acceptable nonhematological toxicity. Patients who underwent auto-SCT after mBuCy had similar survival outcomes and faster neutrophil engraftment than a matched pairs-cohort who underwent auto-SCT after BEAM, indicating that mBuCy can be considered a valid alternative to BEAM.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Lymphoma therapy
Abstract: PB2428
Type: Publication Only
Background
High-dose chemotherapy (HDC) followed by autologous stem cell transplantation (auto-SCT) is superior to conventional chemotherapy in a subgroup of newly diagnosed and relapsed/refractory lymphomas. And BEAM (semustine, etoposide, cytarabine, and melphalan) is one of the most commonly used conditioning regimens. However, the source of melphalan is restricted in China. The conditioning regimen of modified BuCy (busulfan, cyclophosphamide, semustine and cytarabine, mBuCy) has been widely used as the myeloablative regimen for AML and is well tolerated and has shown good efficacy. However, there are limited datum on the efficacy and safety of the mBuCy conditioning regimen in lymphoma auto-SCT. And whether this mBuCy conditioning regimen can be safely used as an alternative to BEAM in lymphoma was uncertain.
Aims
To evaluate the efficacy and toxicity of mBuCy and BEAM regimens.
Methods
From February 2014 to November 2017, a total of 70 Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) patients underwent HDC with mBuCy (n=27) or BEAM (n=43), followed by auto-SCT in our center. As far as the patient's disease status at time of auto-SCT is concerned, we made a 1:1 match. In total, 27 pairs of patients were analyzed.
Results
In our study, we found that there were no significant differences in median number of infused CD34+ cells/kg, hospitalization duration, and median units of transfused red blood cells and platelets, as well as the time of platelet engraftment between the two groups. However, neutrophil engraftment was somewhat faster in mBuCy group than that in the BEAM group (median days: 9 days vs 9.5 days, p=0.038). When it comes to toxicity, the incidence of nausea/vomiting, hepatic impairment, renal impairment, pulmonary infection and treatment-related mortality was found to be similar in the two groups. However, compared with patients conditioned with mBuCy, patients conditioned with BEAM were more likely to develop mucositis and diarrhea (p=0.029; p=0.040). For grade III-IV mucositis and diarrhea, the incidence rate was higher in BEAM (25.9% vs 3.7%; 18.5% vs 0%). With a median follow-up of 15.2 months (range, 3.0 - 41.3 months) in the mBuCy group and 34.9 months (range, 4.6 - 48.0 months) in the BEAM group, we compared the 2-year PFS (72.0% vs 72.0%, p=0.761) and 2-year OS (84.0% vs 77.0%, p=0.783) of the regimens mBuCy and BEAM respectively, which indicated that the two groups were equivalent. Univariate analysis revealed that the International Prognostic Index (IPI) at diagnosis (p=0.046) and the level of serum LDH at transplantation (p=0.002) were the variables associated with PFS. For OS, only the level of serum LDH at transplantation (p=0.010) remained significant. In multivariate analysis, only the level of serum LDH was significantly associated with PFS (p= 0.029, HR: 4.52; 95% CI: 1.17-17.56).
Conclusion
Conditioning regimen of mBuCy was found to be well tolerated with acceptable nonhematological toxicity. Patients who underwent auto-SCT after mBuCy had similar survival outcomes and faster neutrophil engraftment than a matched pairs-cohort who underwent auto-SCT after BEAM, indicating that mBuCy can be considered a valid alternative to BEAM.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Lymphoma therapy