Carmustine, etoposide, cytarabine and melphalan as a preparative regimen for allogeneic transplantation for high-risk malignant lymphoma.
BACKGROUND
The combination of carmustine, etoposide, cytarabine and melphalan (BEAM) is an effective autologous transplantation preparative regimen for lymphoma and has little toxicity, but the feasibility and tolerance of BEAM as a preparative regimen for allogeneic transplantation has not been established.


METHODS
Thirty adults with primary refractory or recurrent intermediate- or low-grade lymphoma were treated on a prospective phase II study with carmustine 300 mg/m2 i.v. day -6, etoposide 200 mg/m2 i.v. followed by cytarabine 200 mg/m2 i.v. twice daily days -5 to -2, melphalan 140 mg/m2 i.v. day -1, and marrow or blood stem cells from an HLA-identical donor on day 0. Tacrolimus and methotrexate were used to prevent graft-vs.-host disease (GVHD).


RESULTS
Median time from transplantation was 20 mos (range 6-32 months). Median maximal regimen-related toxicity grade was 2, and four patients (13%) had a grade 3-4 regimen-related toxicity. Two patients had idiopathic interstitial pneumonitis. One patient had primary graft failure, and a second had autologous reconstitution documented at three months posttransplant. Grades 2-4 acute GVHD occurred in 31%, grades 3-4 in 16%, and chronic GVHD in 54%. Day-100 survival was 70%. Twenty-three patients achieved a complete response. The two-year relapse rate was 23%, survival was 48%, and disease-free survival (DFS) was 42%.


CONCLUSIONS
BEAM supports engraftment of allogeneic transplants and is a tolerable preparative regimen for allogeneic transplantation for lymphoma.
Przepiorka
D
D
Department of Blood and Marrow Transplantation, University of Texas, M.D. Anderson Cancer Center, Houston, USA. donnap@bcm.tmc.edu
van Besien
K
K
Khouri
I
I
Hagemeister
F
F
Samuels
B
B
Folloder
J
J
Ueno
N T
NT
Molldrem
J
J
Mehra
R
R
Körbling
M
M
Giralt
S
S
Gajewski
J
J
Donato
M
M
Cleary
K
K
Claxton
D
D
Braunschweig
I
I
Andersson
B
B
Anderlini
P
P
Champlin
R
R
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D011034:Podophyllotoxin / Q000008:administration & dosage / Q000009:adverse effects; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
D003561:Cytarabine; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine