title: Carmustine, etoposide, cytarabine, and melphalan (BEAM)-campath allogeneic stem cell transplantation for aggressive non-hodgkin lymphoma: an analysis of outcomes from the British Society of Blood and Marrow Transplantation.
abstract: The role of allogeneic stem cell transplantation (SCT) in the management of aggressive non-Hodgkin lymphoma (NHL) remains to be defined, but the number of procedures performed continues to increase. We report here the outcomes of allogeneic SCT using carmustine, etoposide, cytarabine, and melphalan (BEAM)-Campath (Genzyme Corporation, Cambridge, MA) conditioning for aggressive NHL as reported to the British Society of Blood and Marrow Transplantation (BSBMT). This retrospective study identified 46 patients who reported to the BSBMT registry as having undergone BEAM-Campath conditioned allogeneic SCT for aggressive NHL between 1999 and 2010. Disease histology was diffuse large B cell lymphoma (DLBCL, n = 25), DLBCL/Burkitt lymphoma (n = 5), and T cell lymphoma (n = 16). At diagnosis, the median age was 42.5 (range, 17 to 59), 37 had advanced stage disease (Ann Arbor III/IV), 28 had 2 or more extra-nodal sites of disease, and 23 had elevated lactate dehydrogenase. International prognostic index was high or high/intermediate in 58%. The median number of prior therapies was 3 (range, 1 to 5) and 5 patients had previously undergone transplantation (4 autologous, 1 allogeneic). The median age at transplantation was 44.8 (range, 18 to 59), with 34 patients demonstrating chemo-sensitive disease and 22 undergoing transplantation in first response. Performance score was good in 40 patients and all engrafted with a median of 14 days (range, 11 to 27) to neutrophil recovery. At latest follow-up, 20 patients were alive with 17 in complete remission. Acute graft-versus-host disease (GVHD) developed in 7 patients and chronic GVHD developed in 13 (7 limited, 6 extensive). Five patients died from nonrelapse causes, with a cumulative incidence of nonrelapse mortality of 7% at 100 days and 11% at 3 and 5 years. Twenty-one patients died after lymphoma relapse, with a cumulative incidence of relapse/progression of 51% at 1 year and 53% at 5 years. Disease status at transplantation had no impact on relapse rate. Progression-free survival was 41% at 1 year and 36% at 5 years. Overall survival was 54% at 1 year and 42% at 5 years. Overall, BEAM-Campath-conditioned allogeneic SCT is well tolerated and able to deliver durable disease-free survival to a subset of patients with aggressive NHL. However, the high relapse rates indicate further investigation is needed to identify those patients most likely to benefit.
authors.affiliation: University Hospitals Bristol, Bristol, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Truelove
authors.affiliation: Nottingham University Hospitals, Nottingham, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fox
authors.affiliation: University Hospitals Bristol, Bristol, United Kingdom. Electronic address: stephen.robinson@uhbristol.nhs.uk.
authors.forename: Stephen
authors.initials: S
authors.lastname: Robinson
authors.affiliation: British Society of Blood and Marrow Transplantation, London, United Kingdom.
authors.forename: Rachael
authors.initials: R
authors.lastname: Pearce
authors.affiliation: British Society of Blood and Marrow Transplantation, London, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Perry
authors.affiliation: British Society of Blood and Marrow Transplantation, London, United Kingdom.
authors.forename: Keiren
authors.initials: K
authors.lastname: Kirkland
authors.affiliation: Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: Grant
authors.initials: G
authors.lastname: McQuaker
authors.affiliation: Kings College Hospital, London, United Kingdom.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pagliuca
authors.affiliation: Western General Hospital, Edinburgh, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Nottingham University Hospitals, Nottingham, United Kingdom.
authors.forename: Nigel
authors.initials: N
authors.lastname: Russell
authors.affiliation: St. James's Institute of Oncology, Leeds, United Kingdom.
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D064591:Allografts; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D064592:Autografts; D016026:Bone Marrow Transplantation; D002330:Carmustine / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D011034:Podophyllotoxin / Q000008:administration & dosage; D012042:Registries; D012955:Societies, Medical; D015996:Survival Rate; D019172:Transplantation Conditioning; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D003561:Cytarabine; D000074323:Alemtuzumab; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine
keywords: BEAM-Campath; Non-Hodgkin lymphoma; Transplantation