title: LACE versus BEAM conditioning in relapsed and refractory lymphoma transplant: retrospective multicenter analysis of toxicity and efficacy.
abstract: We compared the lomustine, cytarabine, cyclophosphamide and etoposide (LACE) and BCNU, etoposide, cytarabine, melphalan (BEAM) conditioning regimens for toxicity, engraftment kinetics, and efficacy in 139 patients undergoing autologous hematopoietic stem cell transplant for primary refractory or relapsed lymphoma. Ninety-two patients with Hodgkin lymphoma and 47 with non-Hodgkin lymphoma were enrolled. Seventy-five patients received LACE while 64 received BEAM. The incidence of grade 3-4 oral mucositis (9 vs 38%; P < 0.001) and parenteral nutrition requirement (32 vs 69%; P < 0.001) were significantly lower in the LACE cohort. The median days to myeloid (10 vs 11; P = 0.007) and platelet engraftment (13 vs 15; P = 0.026) were shorter for the LACE cohort. Transplant-related mortality in the LACE group was 9% compared to 13% in patients treated with BEAM (P = NS). The probability of overall survival (OS) and progression-free survival (PFS) at 5 years for entire cohort was 46 and 41%, respectively. Probability of OS (LACE 46% vs BEAM 47%; P = NS) and PFS (LACE 37% vs BEAM 47%; P = NS) at 5 years was comparable between two groups. We conclude that LACE has better toxicity profile compared to BEAM and results in similar long-term survival in primary refractory or relapsed lymphoma transplant.
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India. nkhattry@gmail.com.
authors.forename: Navin
authors.initials: N
authors.lastname: Khattry
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Medical Oncology, Jaslok Hospital, Mumbai, India.
authors.forename: Reetu
authors.initials: R
authors.lastname: Jain
authors.affiliation: Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India.
authors.forename: Adwaita
authors.initials: A
authors.lastname: Gore
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Thippeswamy
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India.
authors.forename: Nandish
authors.initials: N
authors.lastname: Jeevangi
authors.affiliation: Department of Biostatistics, ACTREC, Tata Memorial Centre, Navi Mumbai, India.
authors.forename: Sadhana
authors.initials: S
authors.lastname: Kannan
authors.affiliation: Bone Marrow Transplant Unit, Department of Medical Oncology, Room No. 247, Paymaster Shodhika, ACTREC, Tata Memorial Centre, Sector 22, Kharghar, Navi Mumbai, 410210, India.
authors.forename: Reena
authors.initials: R
authors.lastname: Nair
authors.affiliation: Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India.
authors.forename: Tapan
authors.initials: T
authors.lastname: Saikia
mesh_terms: D000293:Adolescent; D000328:Adult; D064592:Autografts; D002330:Carmustine / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage* / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage* / Q000009:adverse effects; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D055815:Young Adult
chemical_list: D003561:Cytarabine; D005047:Etoposide; D008130:Lomustine; D003520:Cyclophosphamide; D008558:Melphalan; D002330:Carmustine
keywords: Conditioning regimen; Hematopoietic stem cell transplantation; Hodgkin lymphoma; Non-Hodgkin lymphoma