Thiotepa-based high-dose therapy for autologous stem cell transplantation in lymphoma: a retrospective study from the EBMT

Abstract

on behalf of the EBMT Lymphoma Working PartyClinical information about thiotepa-based autologous stem cell transplantation (auto-SCT) outside the primary central nervous system lymphoma (PCNSL) field is sparse. In this registry-based retrospective study, we evaluated potential risks and benefits of thiotepa-based preparative regimens compared with BEAM (carmustine, etoposide, cytarabine, melphalan) in auto-SCT for diffuse large B-cell lymphoma (DLBCL, excluding PCNSL), follicular lymphoma (FL) or Hodgkin lymphoma (HL). A total of 14 544 patients (589 thiotepa and 13 955 BEAM) met the eligibility criteria, and 535 thiotepa-and 1031 BEAM-treated patients were matched in a 1:2 ratio for final comparison. No significant differences between thiotepa and BEAM groups for any survival end point were identified in the whole sample or disease entity subsets. For a more detailed analysis, 47 TEAM (thiotepa, etoposide, cytarabine, melphalan)-treated patients were compared with 75 matched BEAM patients with additional collection of toxicity data. Again, there were no significant differences between the two groups for any survival end point. In addition, the frequency of common infectious and non-infectious complications including secondary malignancies was comparable between TEAM and BEAM. These results indicate that thiotepa-based high-dose therapy might be a valuable alternative to BEAM in DLBCL, HL and FL. Further evaluation by prospective clinical trials is warranted.

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

“…The 100‐day and 1‐year NRM were 3.3% and 6.7%, respectively. These rates are similar to those reported in prospective clinical trials for rituximab + BEAM (4.1% 100‐day treatment‐related mortality, TRM) (Vose et al , ) and 131 I‐tositumomab/BEAM (4.9% 100‐day TRM) (Vose et al , ), and to those reported in recent registry‐based or non‐controlled studies of BEAM (4% 1‐year NRM) (Chen et al , ; Sellner et al , ), thiotepa‐based (2% 1‐year NRM) (Sellner et al , ) and fotemustine‐based (2.5% 100‐day and 5.9% 1‐year NRM) (Musso et al , , ) conditioning regimens. In the previous study by Visani et al () of BendaEAM conditioning, the 100‐day TRM was 0%.…”

A Comprehensive Assessment of Toxicities in Patients with Central Nervous System Lymphoma Undergoing Autologous Stem Cell Transplantation Using Thiotepa, Busulfan, and Cyclophosphamide Conditioning

“…18 While many of the grade ≥ 3 non-hematologic toxicities we noted are common after HDT-ASCT, our analysis demonstrates that TBC conditioning is associated with significantly more mucosal toxicity, infections and febrile neutropenia as compared to BEAM or thiotepa, etoposide, cytarabine, melphalan (TEAM). 19 Although their data analysis did not specify all subtypes of infection, the rates of viremia, viral organ disease, and immune-related toxicities we observed appear higher than expected after ASCT.…”

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

“…(Table 3) The European Society for the Blood and Marrow Transplantation (EBMT) working group performed a retrospective study using data from the EBMT database that included a subset analysis comparing R/R NHL patients given BEAM (n ¼ 199) or TEAM (n ¼ 110). [57] At around two years, PFS and OS were 62% versus 49% and 77% versus 77% in the BEAM and TEAM groups, respectively; there were no significant differences between groups. In the EBMT study, 87% of patients receiving TEAM were responsive to prior chemotherapy.…”

“…[57] To our knowledge, only one study has examined the efficacy and safety of the TEAM regimen. (Table 3) The European Society for the Blood and Marrow Transplantation (EBMT) working group performed a retrospective study using data from the EBMT database that included a subset analysis comparing R/R NHL patients given BEAM (n ¼ 199) or TEAM (n ¼ 110).…”