title: Finding the Optimal Conditioning Regimen for Relapsed/Refractory Lymphoma Patients Undergoing Autologous Hematopoietic Cell Transplantation: A Retrospective Comparison of BEAM and High-Dose ICE.
abstract: OBJECTIVE
  High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHCT) is a well-defined treatment modality for relapsed/refractory non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). Although there are several options in terms of conditioning regimens before AHCT, no one treatment is accepted as a standard of care. This study aimed to compare different conditioning regimens for the treatment of NHL and HL.
  
  
  METHODS
  Medical records of 62 patients who had undergone AHCT following BEAM (BCNU, etoposide, cytarabine, and melphalan) and high-dose ICE (hICE; ifosfamide, carboplatin, and etoposide) conditioning regimens were analyzed retrospectively and compared in terms of efficacy and adverse effects.
  
  
  RESULTS
  The study included a total of 29 and 33 patients diagnosed with relapsed/refractory NHL and HL, respectively. Patients received BEAM (n=37) or hICE (n=25) regimens for conditioning. One-year overall survival was 73±6% in all patients. One-year overall survival was 71±8% and 74±9% in the BEAM and hICE groups, respectively (p=0.86). The incidences of nausea/vomiting (grade ≥2) (84% vs. 44.7%; p=0.04) and mucositis (grade ≥2) (13% vs. 3%; p=0.002) were higher in the hICE group compared to the BEAM group. In addition, we witnessed significantly more hepatotoxicity of grade ≥2 (40% vs. 2.7%; p<0.005) and nephrotoxicity of grade ≥2 (48% vs. 2.7%; p<0.005) among patients who received hICE. Significantly more patients (n=4; 25%) in the hICE group experienced veno-occlusive disease (VOD) compared to the BEAM arm, where no patients developed VOD (p=0.01).
  
  
  CONCLUSIONS
  There was no difference in terms of overall survival between the BEAM and hICE groups. We observed significantly more adverse effects among patients treated with hICE. The BEAM regimen seems to be superior to hICE in terms of toxicity profile with comparable efficacy in patients with relapsed/refractory NHL and HL.
authors.forename: Onur
authors.initials: O
authors.lastname: Esbah
authors.forename: Emre
authors.initials: E
authors.lastname: Tekgündüz
authors.affiliation: Ankara Oncology Hospital, Hematology and Stem Cell Transplantation Unit, Ankara, Turkey, Phone : +90 0532 296 89 98, E-mail: dritir@hotmail.com.
authors.forename: Itır
authors.initials: I
authors.lastname: Şirinoğlu Demiriz
authors.forename: Sinem
authors.initials: S
authors.lastname: Civriz Bozdağ
authors.forename: Ali
authors.initials: A
authors.lastname: Kaya
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Tetik
authors.forename: Ömür
authors.initials: Ö
authors.lastname: Kayıkçı
authors.forename: Gamze
authors.initials: G
authors.lastname: Durgun
authors.forename: Şerife
authors.initials: Ş
authors.lastname: Kocubaba
authors.forename: Fevzi
authors.initials: F
authors.lastname: Altuntaş
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000009:adverse effects / Q000627:therapeutic use; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D003561:Cytarabine; D005047:Etoposide; D016190:Carboplatin; D008558:Melphalan; D007069:Ifosfamide