Bucye Can Safely Replace BEAM As Conditioning Regimen for Autologous Stem Cell Transplantation for Relapsed Lymphomas

Introduction Hodgkin's and non-Hodgkin's lymphomas are the most frequent hematological neoplasms and have a marked variability in their behavior. Although they usually are chemosensitive and attend with high cure rates, a small portion of the patients will relapse or be refractory to the initial treatment. In this context, high-dose chemotherapy followed by consolidation with autologous stem cell transplantation (aHSCT) is still the standard of care. BEAM and BUCYE are two chemotherapy protocols used as conditioning regimens. Objectives The main objective of this study was to compare the overall survival (OS) and progression-free survival (PFS) of patients with relapsed or recurrent Hodgkin (HL) and non-Hodgkin lymphomas (NHL) treated with BEAM or BUCYE as conditioning regimens and undergoing autologous stem cell transplantation. Furthermore, OS and PFS related to each regimen was evaluated separately for type of lymphoma. Methods We retrospectively reviewed of 122 medical records of patients with refractory or relapsed Hodgkin and non-Hodgkin's lymphoma submitted to autologous bone marrow transplantation with BEAM or BUCYE conditioning regimens, treated at A.C.Camargo Cancer Center from January of 2009 to May of 2017. OS and PFS were calculated using the Kaplan-Meier method and the log rank test was employed to compare time to event between the groups. Toxicity and engraftment data were evaluated with Mann-Whitney and chi-square tests. Results The cohort was divided in two groups, those undergoing BEAM conditioning (n = 77) and those submitted to BUCYE conditioning (n = 45). The median age was 42 years. Most clinical characteristics were similar in both groups. Regarding the toxicity profile, the only difference observed was a higher frequency of mucositis grade ≥2 in the BUCYE group (p=0,01). The median time for neutrophils engraftment in the BEAM and BUCYE groups was 10 and 9 days (p=0,40) respectively. For platelets engraftment, the median time was 10 days for both groups (p=0,35). No significant difference in overall survival or progression-free survival was observed among patients treated with BEAM or BUCYE. However, when the patients treated with each regimen were evaluated according to the lymphoma subtype, the BEAM regimen was associated with prolonged overall survival (p=0.02) when compared with the BUCYE regimen in patients with non-Hodgkin's lymphoma. Conclusion BEAM and BUCYE are well tolerated and have similar toxicity profile, as well as similar engraftment time and survival, except for a higher rate of mucositis associated with BUCYE. Patients with non-Hodgkin's lymphoma seem to benefit from treatment with the BEAM regimen.