1. Conclusions/Comments
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 Rauf1, Panayotis Kaloyannidis2, Irfan Maghfoor1, Solaf Kafnar2, John Apostolidis2 Khalid Al Anezi2, Harbi Salman2, Shaibani Eshrak2, Jenifer Bacal2, Tusneem A.M. Elhassan1, Saad Akhtar1, Hani Al Hashmi2
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
Background
Survival curves for the whole cohort of patients (n=112)
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
Overall survival
Progression free survival
Aim of the study
To compare BEAM vs. HDM (200mg/m2) regimens in patients with RR-HL who underwent ASCT in terms of:
Safety
Efficacy
Survival curves for patients in PR before ASCT (n=60)
Methods
Overall survival
Progression free survival
Type of study:
Retrospective, Matched paired (1:3)
Collaborative of 2 centers from Saudi Arabia
Study period: November 2008-May 2017
Total
HDM
BEAM
p- value
Number of patients
112 28 84
Median Age 30 ns
Gender (M/F)
71/41
18/10
53/31
Days for Conditioning 1 6
GCSF initiation post-ASCT
Day +5
Day +1
Matched variables (1:3)
Pre-Salvage Therapy
Late Relapse 48 12 36
Early Relapse/Refractory 64 16
Response status before ASCT
Complete Response (CR) 52 13 39
Partial Response (PR) 60 15 45
Survival curves for patients in CR before ASCT (n=52)
Overall survival
Progression free survival
Results
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:
HDM is safe and equally effective to BEAM at least for patients in CR at the time of ASCT
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 HL-patients.
HDM
BEAM
Absolute difference
p- value
ANCs > 500/mm3
+11 ns
PLTs > 20,000/mm3
+13
+22
9 days
0.001
The whole cohort (n=112)
5-years OS
80%
68%
12 %
5-years PFS
65%
52%
13 %
TRM
3.5%
2.3%
1.2 %
Post-Salvage PR
83%
60%
23 %
40%
25 %
Post-Salvage CR
77%
75%
2 %
67%
1 %
Median F/U 2 years