High-dose Bendamustine-EAM followed by autologous stem cell rescue results in long-term remission rates in lymphoma patients, without renal toxicity

BackgroundAutologous stem cell transplantation (ASCT) following BEAM (BCNU, etoposide, cytarabine, melphalan) conditioning is standard of care in relapsed low- and high-grade B-cell lymphoma (DLBCL) and other lymphoproliferative disorders, but BCNU is associated with interstitial pneumonia and an increased mortality. A less toxic regimen might improve the outcome of patients with lymphoma after transplantation. ObjectivesWe investigated the role of bendamustine replacing BCNU in the BEAM regimen in patients with lymphoma undergoing ASCT. Patients/MethodsThe conditioning regimen BendaEAM consisted of bendamustine, cytarabine, etoposide, and melphalan and was used in patients with Hodgkins disease (HD) and Non-Hodgkin lymphoma (NHL). ResultsForty-one patients with HD (n=9) or NHL (n=32) were consecutively treated with Benda-BEAM replacing BCNU. No pulmonary or renal toxicities occurred, and no patient died related to transplant. After a median follow-up of 55months, CR rate was 56%, 18 patients (44%) showed progression after a median time of 7months after transplantation (range: 2-29months), and 11 patients (24%) have died, all due to lymphoma progression. The 1-, 2-, and 4-year PFS are 73.2%, 58.6%, and 55.6% and the 1-, 2-, and 4-year OS 85.4%, 78.0%, and 72.6%, respectively. ConclusionBendaEAM seems to be feasible with a promising response rate and acceptable toxicity.