BEAM vs single agent high dose Melphalan conditioning
BEAM vs. single agent high dose Melphalan conditioning regimen for autologous hematopoietic stem cell transplantation: A retrospective matched analysis in relapsed/refractory Hodgkin Lymphoma M S Rauf 1, Panayotis Kaloyannidis 2, Irfan Maghfoor 1, Solaf Kafnar 2, 2 2 John Apostolidis Khalid Al Anezi , Harbi Salman , Shaibani Eshrak , 2 1 1 2 Jenifer Bacal , Tusneem A. M. Elhassan , Saad Akhtar , Hani Al Hashmi 1. King Faisal Hospital and Research Center, Oncology Center, Riyadh, Saudi Arabia 2. King Fahad Specialist Hospital, Adult Hematology & Stem Cell Transplantation Department, Dammam, Saudi Arabia Survival curves for the whole cohort of patients (n=112) Progression free survival Overall survival Background The ideal conditioning regimen still remains a challenge for patients undergoing autologous stem cell transplantation (ASCT) for relapsed/refractory Hodgkin Lymphoma (RR-HL). The commonly used regimen is BEAM but single agent high-dose Melphalan (HDM) has also been used, however so far, there are limited experience and data comparing BEAM vs. HDM Aim of the study To compare BEAM vs. HDM (200 mg/m 2) regimens in patients with RR-HL who underwent ASCT in terms of: Ø Safety Ø Efficacy Methods Survival curves for patients in PR before ASCT (n=60) Progression free survival Overall survival Type of study: • Retrospective, Matched paired (1: 3) • Collaborative of 2 centers from Saudi Arabia Study period: November 2008 -May 2017 Total 112 HDM BEAM 28 84 30 30 71/41 18/10 53/31 1 6 Day +5 Day +1 Number of patients Median Age Gender (M/F) Days for Conditioning GCSF initiation post-ASCT Matched variables (1: 3) Pre-Salvage Therapy Late Relapse Early Relapse/Refractory Response status before ASCT Complete Response (CR) Partial Response (PR) 48 64 12 16 36 48 52 60 13 15 39 45 p- value ns ns Survival curves for patients in CR before ASCT (n=52) Progression free survival Overall survival Results Median F/U 2 years HDM ANCs > 500/mm 3 +11 PLTs > 20, 000/mm 3 +13 The whole cohort (n=112) 5 -years OS 80% 5 -years PFS 65% TRM 3. 5% Post-Salvage PR 5 -years OS 83% 5 -years PFS 65% Post-Salvage CR 5 -years OS 77% 5 -years PFS 67% #EBMT 18 p- value Ø +11 +22 Absolute difference 0 9 days ns 0. 001 Ø 68% 52% 2. 3% 12 % 13 % 1. 2 % ns ns ns 60% 40% 23 % 25 % ns ns BEAM 75% 68% 2% 1% ns ns Ø Ø Conclusions/Comments To the best of our knowledge this study, though retrospective , is the first that compares in a matched-pair basis (1: 3) the HDM with the “gold standard” regimen BEAM From our results it seems that: Ø HDM is safe and equally effective to BEAM at least for patients in CR at the time of ASCT Ø Noteworthy, for patients in PR before ASCT, HDM offered better survival rates, though not statistically significant 5 days duration difference between the two conditioning protocols (1 vs 6 days), less days of GCSF use, and faster PLTs recovery may contribute to a better cost effectiveness for the HDM regimen Prospective studies, and longer follow-up, including also a meticulous cost analysis, are warranted to determine the accurate role of single agent HDM as preparative regimen for ASCT in HLpatients. www. ebmt. org
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