scholarly journals Matched Pair Analysis of Efficacy and Toxicity of Conditioning BEAM and Busilvex Based Regimen in Autologous Hematopoietic Cell Transplantation for Lymphomas: Preliminary Results

2013 ◽  
Vol 19 (2) ◽  
pp. S238-S239
Author(s):  
Ioanna Sakellari ◽  
Despina Mallouri ◽  
Damianos Sotiropoulos ◽  
Ioannis Batsis ◽  
Varnavas Konstantinou ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Matched Pair ◽  
Preliminary Results ◽  
Matched Pair Analysis ◽  
Pair Analysis ◽  
Autologous Hematopoietic Cell Transplantation

Efficacy and Toxicity of Conditioning Regimens BEAM and BEM in Autologous Hematopoietic Cell Transplantation for Lymphomas: Preliminary Results of a Comparative (Matched Pair) Analysis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4530-4530
Author(s):  
Ioanna Sakellari ◽  
Despina Mallouri ◽  
Batsis Ioannis ◽  
Constantinou Varnavas ◽  
Iskas Michalis ◽  
...  
Keyword(s):  
Hematopoietic Cell Transplantation ◽  
Salvage Treatment ◽  
Matched Pair ◽  
Matched Pair Analysis ◽  
Stage Disease ◽  
Group A ◽  
Conditioning Regimens ◽  
Group B ◽  
Pair Analysis ◽  
Autologous Hematopoietic Cell Transplantation

Abstract Abstract 4530 Autologous hematopoietic cell transplantation (AHCT) is the standard of care for relapsed or primary refractory Hodgkin's (HL) and Non Hodgkin's lymphoma (NHL). The conditioning regimens used are considered equal and none has demonstrated any superiority. During the last 2 years, primarily due to Carmustine (BCNU) unavailability, a new alternative conditioning regimen was constructed in our unit consisting of intravenous Busulphan (Busilvex) (3.2mg/kg/day for 3 days), Etoposide (400mg/m∧2/day for 2 days) and Melphalan (140mg/m∧2) (BEM). We retrospectively analysed the outcome of patients (pts) who underwent AHCT following conditioning with the standard BEAM and BEM regimen. The pts were stratified by age, pre-transplantation disease phase and previous lines of treatment. In total, 50 pts conditioned with BEM (group A) and 93 pts with BEAM (group B) were included. Group B pts were selected among 184 pts who underwent AHCT with BEAM regimen during the last decade. Stratification by disease risk was followed by a 1:2 selection. Fifty percent of the pts were younger than 34 in both study groups with a range of 11–68 years old. The pts of group B were more likely to suffer from HL (63) than NHL (30); whereas disease diagnosis for group A was HL in 28 and NHL in 22 pts. Disease was chemoresistant to salvage treatment in 46% of group A pts versus (vs) 23% of group B pts. There were no other significant differences concerning the patients' characteristics such as age above median, pre-transplantation lines of treatment (1–2: 40%, 3–4: 46%, ≥5: 14%), disease status (complete remission: 27%, primary refractory: 52%, relapse: 21%), advanced stage disease (52%). Complete remission post-AHCT was obtained in 50% of group A and 56% of group B pts. Progression free survival (PFS) at 2 years and overall survival (OS) were similar among the two study group populations (66% vs 63% and 80% vs 78% respectively). Given the fact that there were more pts with chemoresistant disease in group A, a second matched pair analysis was conducted upon stratification by disease chemosensitivity to salvage treatment instead of age as a risk factor. Efficacy was again similar for both conditioning regimens. In multivariate analysis favorable factors in terms of PFS were HL, chemosensitivity to salvage treatment and stage <IIB whereas in terms of OS non-bulky disease, HL and stage <IIB. Treatment related mortality (TRM) was 3.2% (3/93 pts) in group B and no TRM in group A. Detailed toxicity associated with the two study regimens is further analyzed. There are currently no randomized studies clarifying the optimal conditioning among multiple regimens in terms of efficacy and toxicity. In this study the two conditioning regimens, BEAM and BEM, were found to be equivalent. Additionally, the efficacy of the newly designed BEM regimen in chemoresistant and advanced stage disease is encouraging. Disclosures: No relevant conflicts of interest to declare.

A matched pair analysis of conditioning BuEM versus BEAM in autologous haematopoietic cell transplantation for lymphomas in terms of toxicity and efficacy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8567-8567
Author(s):  
Ioanna Sakellari ◽  
Despina Mallouri ◽  
Ioannis Batsis ◽  
Chryssoula Apostolou ◽  
Varnavas Konstantinou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Liver Toxicity ◽  
Conditioning Regimen ◽  
Matched Pair ◽  
Matched Pair Analysis ◽  
Matching Criteria ◽  
Pair Analysis ◽  
Early Toxicity

8567 Background: In autologous hematopoietic cell transplantation (AHCT) for lymphomas, the optimal conditioning regimen is currently investigated. The standard conditioning used is BEAM. During 2009-2011 a new alternative Busulphan-based conditioning regimen constructed in our unit, consisting of Busilvex (9.6 mg/Kg), Etoposide (9.6 mg/Kg) and Melphalan (140mg/m^2) (BuEM) was used. We retrospectively analysed the outcome of patients (pts) conditioned with BEAM and BuEM regimen, in terms of toxicity and efficacy, in a matched pair analysis. Methods: A matched paired analysis on a 1:2 ratio was performed. Thus, 2 control cases (receiving BEAM regimen) were matched to each patient treated with BuEM according to: phase of transplant, age, lines of previous chemotherapy. The first 50 consecutive pts treated with BuEM were matched to a random sample from the historical BEAM control population. Ninety-three BEAM pts that fulfilled the matching criteria were eventually randomly selected. Concerning pts characteristics there were no statistical significant differences except from more chemoresistant disease in the BuEM cohort (p=0.008). Thus a second matched pair analysis was conducted upon stratification by disease chemosensitivity instead of age as a risk factor. Results: Progression free survival and overall survival (OS) were 70.6% and 81.8% for the BEAM vs 68.9% and 83% for the BuEM cohort respectively (p=ns). In the BuEM cohort a borderline significantly better OS was noted in Hodgkin’s pts receiving BuEM (p=0.05). In terms of early toxicity a significantly faster neutrophil engraftment was found in the BEAM cohort, but there was a significantly less need of red blood cells, platelet transfusions and GCSF infusion in the BuEM cohort. BEAM regimen was also associated with: reduced incidence of infections (p=0.02), less severe (grade 3-4) mucositis (p=0.000) and liver toxicity (p=0.004). Conclusions: BEAM regimen was correlated with a favourable reduced early toxicity profile, ie severe mucositis and liver impairment. On the other hand, BuEM was found to be equally efficacious and moreover offered improved overall survival in Hodgkin’s lymphoma pts.

Autologous Hematopoietic Cell Transplantation in Patients With Multiple Myeloma: Effect of Age

2017 ◽  
Vol 17 (3) ◽  
pp. 165-172 ◽  
Author(s):  
Binod Dhakal ◽  
Ariel Nelson ◽  
Guru Subramanian Guru Murthy ◽  
Raphael Fraser ◽  
Daniel Eastwood ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Effect Of Age ◽  
Autologous Hematopoietic Cell Transplantation

Longitudinal Assessment of Hematopoietic Abnormalities After Autologous Hematopoietic Cell Transplantation for Lymphoma

2005 ◽  
Vol 23 (27) ◽  
pp. 6699-6711 ◽  
Author(s):  
Ravi Bhatia ◽  
Khristine Van Heijzen ◽  
Ann Palmer ◽  
Asako Komiya ◽  
Marilyn L. Slovak ◽  
...  
Keyword(s):  
Stem Cells ◽  
Telomere Length ◽  
Cell Transplantation ◽  
Hodgkin’S Lymphoma ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Hodgkin's Lymphoma ◽  
Autologous Hct ◽  
Prospective Longitudinal ◽  
Autologous Hematopoietic Cell Transplantation

Purpose Autologous hematopoietic cell transplantation (HCT) is being increasingly used as an effective treatment strategy for patients with relapsed or refractory Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) but is associated with therapy-related myelodysplasia and acute myeloid leukemia (t-MDS/AML) as a major cause of nonrelapse mortality. The phenomenon of hematopoietic reconstitution after autologous HCT and the role of proliferative stress in the pathogenesis of t-MDS/AML are poorly understood. Patients and Methods Using a prospective longitudinal study design, we evaluated the nature and timing of alterations in hematopoietic progenitors and telomere length after HCT in patients undergoing autologous HCT at City of Hope Cancer Center (Duarte, CA). Results A significant reduction in primitive and committed progenitors was observed before HCT compared with healthy controls. Further profound and persistent reduction in primitive progenitors but only transient reduction in committed progenitors were seen after HCT. Primitive progenitor frequency in pre-HCT marrow and peripheral-blood stem cells predicted for primitive progenitor recovery after HCT. Shortening of telomere length was observed in marrow cells early after HCT, with subsequent restoration to pre-HCT levels. Patients within this cohort who developed t-MDS/AML had reduced recovery of committed progenitors and poorer telomere recovery, possibly indicating a functional defect in primitive hematopoietic cells. Conclusion Our studies suggest that hematopoietic regeneration after HCT is associated with increased proliferation and differentiation of primitive progenitors. Increased proliferative stress on stem cells bearing genotoxic damage could contribute to the pathogenesis of t-MDS/AML. Extended follow-up of a larger number of patients is required to confirm whether alterations in progenitor and telomere recovery predict for increased risk of t-MDS/AML.

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