title: Retrospective evaluation of the MEAM regimen as a conditioning regimen before autologous peripheral blood stem cell transplantation for lymphoma in two centers with different dosing schedules of melphalan.
abstract: The BEAM regimen consisting of carmustine (BCNU), etoposide, cytarabine, and melphalan (MEL) is widely used before autologous hematopoietic stem cell transplantation (auto-HSCT) for lymphoma. However, intravenous BCNU is not available in Japan, and therefore, ranimustine (MCNU) has been used instead of BCNU (the MEAM regimen). We retrospectively analyzed the outcome of 79 adult patients who underwent auto-HSCT for lymphoma using this regimen in two centers, with 1- and 2-day dosing of MEL, respectively. Three-year overall survival (OS) and progression-free survival (PFS) probabilities were 77.3 and 56.5 % in the entire population and 71.7 and 58.0 % in patients with diffuse large B cell lymphoma. These outcomes were at least equivalent to those with the BEAM regimen. There was no regimen-related pulmonary toxicity. In a multivariate analysis, older age was the only factor that was significantly associated with for OS. In a comparison of the two MEL dosing schedules, while there was no significant differences in either OS or PFS, diarrhea was observed more frequently with 1-day dosing of MEL. In conclusion, the MEAM regimen appeared to be a promising conditioning regimen in auto-HSCT for lymphoma. A large prospective study is warranted to confirm the current findings.
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ito
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Mashima
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Kento
authors.initials: K
authors.lastname: Umino
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Minakata
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakano
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kawasaki
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ashizawa
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Yamamoto
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Okazuka
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Hatano
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Iekuni
authors.initials: I
authors.lastname: Oh
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohmine
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Muroi
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan. ycanda-tky@umin.ac.jp.|Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan. ycanda-tky@umin.ac.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000139:chemically induced; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000145:classification / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009607:Nitrosourea Compounds / Q000008:administration & dosage / Q000009:adverse effects; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009607:Nitrosourea Compounds; D003561:Cytarabine; D005047:Etoposide; D008558:Melphalan; C020766:ranimustine
keywords: Autologous hematopoietic stem cell transplantation; Lymphoma; Melphalan; Ranimustine