BeEAM conditioning with bendamustine-replacing BCNU before autologous transplantation is safe and effective in lymphoma patients

Abstract

BEAM with BCNU is commonly used for conditioning treatment followed by autologous stem cell transplantation (ASCT). However, pulmonary toxicity and availability issues associated with BCNU prompted us to evaluate bendamustine-replacing BCNU (BeEAM). We analyzed 39 lymphoma patients receiving BeEAM conditioning with 200 mg/m bendamustine at days -7 and -6. The median duration until neutrophil recovery was 11 days, and 15 days for platelet recovery (>20 g/L). The most common grade 3/4 non-hematologic toxicities comprised mucosal side effects (27 pts.). Pulmonary toxicity was observed in one patient (2.5%), and one patient died of septic complications. The CR rate increased from 33% to 74% 100 days after ASCT. After a median follow-up of 18.5 months, progression and death each occurred in 11 patients (28%). Median progression-free and overall survival at 2 years were 69% and 72%. Our data suggest that BeEAM conditioning using bendamustine is safe and results in promising survival rates.

Dose‐intensified bendamustine and melphalan (BenMel) conditioning before second autologous transplantation in myeloma patients

“…Second, the additional renal toxicity associated with intensified‐dose bendamustine may be relevant, with 25% of the patients developing rAKI grade 2 or 3, which was fully reversible until dismissal in all patients. A forced hydration strategy before and after bendamustine administration, as well as the 2‐hour administration, appears to be crucial, which is similar to experiences with BeEAM HDCT in lymphoma patients . Finally, we did not observe evidence of cardiotoxicity in patients receiving HDBenMel, despite reported cardiotoxicity in previous series at higher doses of bendamustine .…”

“…In a appears to be crucial, which is similar to experiences with BeEAM HDCT in lymphoma patients. 19 Finally, we did not observe evidence of cardiotoxicity in patients receiving HDBenMel, despite reported cardiotoxicity in previous series at higher doses of bendamustine. 40,41 Overall, the HDBenMel conditioning regimen showed a favorable tolerability profile, and stem cell engraftment was successful in all patients.…”

“…The median duration of hospitalization was 18 days (range [15][16][17][18][19][20][21][22][23] after HDBenMel/ASCT2 versus 17 days (range 16-20) after HDMel/ ASCT1. Thus, the median and the maximum duration of hospitalization were only slightly longer for the HDBenMel regimen.…”

“…In lymphoma patients, we previously reported that high-dose bendamustine (200 mg/m 2 ) could be safely combined with etoposide, cytarabine, and melphalan (BeEAM regimen). 19 Accordingly, we investigated in this report the feasibility and efficacy of the HDBenMel conditioning regimen before the second (tandem) ASCT in first remission in high-risk myeloma patients who had previously received HDMel before the first ASCT.…”

Bendamustine as part of conditioning of autologous stem cell transplantation in patients with aggressive lymphoma: a phase 2 study from the GELTAMO group

“…In the previous prospective clinical trial (Visani et al, 2014), BendaEAM produced a 72% 3-year PFS, although their series also included patients with HL, as stated before. In a single-centre retrospective study, BendaEAM resulted in a 69% and 72% 2-year PFS and OS, respectively, although this series (n = 39) was very heterogenous, including patients with HL, DLBCL, PTCL, MCL, FL and other indolent lymphomas (Gilli et al, 2017), so the efficacy results of these studies are not comparable with ours. Several recent registry analyses have compared the efficacy of a number of commonly used conditioning regimens in lymphoma patients (Chen et al, 2015;Sellner et al, 2016).…”