BuCyE can safely replace BEAM as a conditioning regimen for autologous stem cell transplantation in the treatment of refractory and relapsed lymphomas.

Abstract Introduction Hodgkin's (HL) and non-Hodgkin's (NHL) lymphomas are usually chemosensitive with high cure rates. The standard of care for the minority of patients who suffer from relapse or treatment-refractory HL or NHL is salvage chemotherapy followed by consolidation with autologous hematopoietic stem cell transplantation (AHSCT). Due to carmustine and melphalan shortages, alternative pre-AHSCT conditioning regimens with similar tolerance and response were needed. Objectives Overall survival (OS) and progression-free survival (PFS) were compared between relapsed/recurrent HL/NHL patients given BEAM (carmustine, etoposide, cytarabine, and melphalan) or BuCyE (busulfan, cyclophosphamide, and etoposide) conditioning regimens. OS and PFS were also compared according to lymphoma subtype. Methods We conducted retrospective analyses of the medical records of 122 patients with refractory or relapsed HL and NHL given BEAM or BUCYE prior to AHSCT at our institution from January of 2009 to May of 2017. OS and PFS calculated by the Kaplan-Meier method were compared between treatment groups by log rank tests. Toxicity and engraftment data were compared with Pearson's chi-square and Mann-Whitney tests, respectively. Results Most clinical characteristics were similar between the BEAM and BuCyE groups. We observed a longer hospital stay (p = .004) and higher frequency of grade ≥ 2 mucositis (p = .01) in the BuCyE group than in the BEAM group. No significant difference in OS or PFS were observed between the two groups. Conclusion BEAM and BuCyE are well tolerated and have similar toxicity profiles and survival outcomes, except for a higher mucositis rate and longer hospital stay associated with the latter. Therefore, the BuCyE conditioning regimen can be considered as an alternative to BEAM conditioning.