Safety and efficacy of BEAC conditioning in HL and NHL

A retrospective analysis on the safety and efficacy of carmustine, etoposide, cytarabine, and cyclophosphamide (BEAC) conditioning in autologous hematopoietic cell transplantation (AHCT) in both Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), was recently published in Bone Marrow Transplantation, by Ioanna Sakellari from George Papanikolaou Hospital, Thessaloniki, GR, and colleagues.

Finding the safest and most efficient AHCT conditioning regimen is crucial in lymphomas. Carmustine, etoposide, cytarabine, and melphalan (BEAM) is the most frequently used conditioning in NHL and HL. Nevertheless, availability issues with melphalan and carmustine have led to the introduction of BEAC and busulfan EM (BuEM), respectively, as potential replacements. The aim of this study was to retrospectively compare the efficacy and safety of BEAC versus BuEM in both NHL and HL patients.

Study design

• N = 100 patients, who received either BEAC (n = 33) between 2016–2017, or BuEM (n =67) between 2011–2013, at the investigators’ center
• Dosing:
  • BEAC:
    • B: 300 mg/m²
    • E: 800 mg/m²
    • A: 800 mg/m²
    • C: 140 mg/kg
  • BuEM:
    • Bu: 9.6 mg/kg
    • E: 800 mg/m²
    • M: 140 mg/m²
  • No differences in baseline characteristics between the two groups (BEAC vs BuEM)
  • Days of neutropil and platelet engraftment or transfusion needs were similar between the groups (P = 0.657, P = 0.572, and P =0.114, respectively)

Key findings

• At more than 100 days follow-up:
  • The amount of patients receiving additional therapy after AHCT were similar in both groups (P = 0.492)
  • No significant difference was observed in overall survival (OS; P = 0.301) or non-relapse mortality (NRM; P = 0.495) rates between the groups
• At a median follow-up of 22.7 months (range, 2.1–29.8) for BEAC and 44.9 months (2.3–77.1) for BuEM:
  • Two-year OS: 75.7% (BEAC) vs1% (BuEM) [P = 0.301]
  • Two-year cumulative NRM incidence: 4.3% (BEAC) vs6% (BuEM) [P = 0.495]
• Multivariate analysis revealed that HL diagnosis (P = 0.001) and pre-transplant chemosensitive disease (P = 0.005) were independent OS predictors
• The sole independent predictor of NRM was pre-transplant chemosensitive disease (P < 0.001)

Safety

• BEAC patients had significantly lower infection rates (51.5%) than those in the BuEM group (91%; P < 0.001)
• BEAC patients presented with significantly lower World Health Organization (WHO) grade 3–4 mucositis than those in the BuEM group (P < 0.001)
• BEAC patients presented with significantly lower gastrointestinal and liver toxicity than those in the BuEM group (P = 0.025 and P = 0.013, respectively)

The results of this retrospective analysis indicate that BEAC is a safer AHCT conditioning regimen than BuEM in HL and NHL patients. Both BEAC and BuEM resulted in similar outcomes in NHL and HL patients, therefore further supporting the authors’ recommendation for using BEAC as an alternative conditioning regimen in lymphomas.