A Retrospective, Matched Paired Analysis Comparing GBM/GBC Versus BEAM/Beac Conditioning Regimen for Autologous Stem Cell Transplantation in Non-Hodgkin’s Lymphoma

Objective: Since BCNU was in short supply across China, we explored alternative conditioning regimens gemcitabine, busulfan combined with melphalan/cyclophosphamide (GBM/GBC) followed by ASCT in lymphoma patients (Bone Marrow Transplant. 2022; 57(6):1017-1020). Herein, we compared the safety and efficacy of GBM/GBC versus carmustine, etoposide, cytarabine combined with melphalan/cyclophosphamide (BEAM/BEAC) conditioning regimen for autologous stem cell transplantation (ASCT) in non-Hodgkin’s lymphoma (NHL).

Methods: A comparative analysis of matching cohorts was performed to compare the side effects, hematopoiesis recovery time, treatment response, and long-term survival of GBM/GBC versus BEAM/BEAC conditioning regimen followed by ASCT in NHL. From October 2010 to October 2021, a total of 204 patients at the lymphoma and myeloma center of Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College were identified: 92 patients were in the BEAM/BEAC group and 112 in the GBM/GBC group.

Results: There was no statistical difference in baseline characteristics between the two groups, and first-line treatment patients accounted for 69.6% and 72.3% in the GBM/GBC and BEAM/BEAC groups, respectively. The incidence of grade 3/4 hematological toxicity showed no statistical difference between the two groups. Also, there was no statistical difference in the incidence of grade 3/4 non-hematologic side effects, including fever/infection, nausea, vomiting, diarrhea, oral mucositis, cardiotoxicity, renal toxicity and neurotoxicity. However, the incidence of grade 3/4 rashes (28.6% vs 0%, p< 0.001) and hepatopathy (28.2% vs 3.3%, p<0.001) was higher in the GBM/GBC group versus the BEAM/BEAC group, which could be recovered after appropriate treatment. VOD and treatment-related death did not occur during the study. No patients experienced graft failure. The median time to neutrophil engraftment was 10 days in both groups and platelet engraftment was 12 days (GBM/GBC group) versus 11 days (BEAM/BEAC group) (p=0.130), respectively. The complete response (CR) rates in the GBM/GBC group and the BEAM/BEAC group at 3 months after transplantation were 93.5% and 91.1%, respectively (p=0.537), and there was no difference in the estimated 3-year PFS (80.4% vs 83.5%; p=0.771) and the estimated 3-year OS (88.5% vs 92.3%; p=0.620).

Conclusion: In this retrospective, matched paired analysis, our results demonstrate that GBM/GBC conditioning regimens with ASCT are feasible with tolerable toxicity, which appears be an alternative to the classical BEAM/BEAC conditioning regimens for ASCT in the treatment of NHL.