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Introduction Hodgkin's (HL) and non-Hodgkin's (NHL) lymphomas are the most frequent hematological neoplasms and have a marked variability in their behavior. Although they usually are chemosensitive and attend with high cure rates, a small portion of the patients will relapse or be refractory to the initial treatment. In this context, high-dose chemotherapy followed by consolidation with autologous stem cell transplantation (AHSCT) is still the standard of care. Carmustine-based conditioning regimens, which includes the combination of Carmustine, Etoposide, Cytarabine and Melphalan (BEAM) are mostly used. However, due to the shortage of carmustine and melphalan, replacing BEAM by Busulfan, Cyclophosphamide and Etoposide (BUCYE), another regimen with apparently similar tolerance and response, has been needed. Objectives The main objective of this study was to compare the overall survival (OS) and progression-free survival (PFS) of patients with relapsed or recurrent HL and NHL treated with BEAM or BUCYE as conditioning regimens and undergoing AHSCT. In addition, OS and PFS according to the lymphoma's type, related to each regimen, was evaluated. Methods We retrospectively reviewed 122 medical records of patients with refractory or relapsed HL and NHL submitted to AHSCT with BEAM or BUCYE conditioning regimens, treated at A.C.Camargo Cancer Center from January of 2009 to May of 2017. OS and PFS between the groups, were calculated using the Kaplan-Meier method and compared by the log rank test. Toxicity and engraftment data were evaluated with Mann-Whitney and chi-square tests. Results The cohort was divided in two groups, those undergoing BEAM conditioning (n = 77) and those submitted to BUCYE conditioning (n = 45). The median age was 42 years. Most clinical characteristics were similar in both groups. Regarding the toxicity profile, we observed, a longer in-hospital stay (p=0,004) and a higher frequency of mucositis grade ≥2 (p=0,01) in the BUCYE group. The median time for neutrophils engraftment in the BEAM and BUCYE groups was 10 and 9 days (p=0,40) respectively. For platelets engraftment, the median time was 10 days for both groups (p=0,35). No significant difference in overall survival or progression-free survival was observed among patients treated with BEAM or BUCYE, regardless of diagnosis. Conclusion BEAM and BUCYE are well tolerated and have similar toxicity profile, as well as similar engraftment time and survival, except for a higher rate of mucositis and a longer in-hospital stay associated with BUCYE. Therefore, BUCYE conditioning regimen can be considered as an alternative to BEAM. |
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