BEAM myeloablative chemotherapy followed by autologous stem cell rescue is an effective salvage therapy for patients with malignant lymphoma

Several pre-transplant conditioning regimens are currently being used prior to autologous stem cell rescue in patients with malignant lymphoma. Our earlier results achieved with BEAM chemotherapy encouraged us to proceed with safety/effectiveness study of this conditioning regimen, this time specifically focusing on the subgroup of pretreated lymphoma patients with active disease. Fifty one pretreated patients with active lymphoma received BEAM chemotherapy followed by autologous stem cell rescue. There were 31 male and 20 female patients with a median age of 36 (range 18-63). Thirty one patients had Non-Hodgkin's lymphoma and 20 patients had Hodgkin's disease. All patients were heavily pretreated receiving a median of 2 different lines of chemotherapy (range 1-6) and a median of 8 chemotherapeutic cycles (range 2-31). An average of 4.70 (range 0.79-20.9, SD 4.89) × 106/kg CD34+ cells was reinfused, MNC averaging 2.69 (range 0.53-11.35, SD 2.02) × 108/kg. G-CSF (5 ľg/kg) was administered during the leukopenic period to all but one patient (mean 10 days, range 6-22). This resulted in a median duration of leukopenia ( 1 × 109/L) was 11 days post transplant (range 6-20). Median time to platelet recovery (>20 × 109/L) was 14 days (range 6-30). During the cytopenic period patients were supported with an average of 19 platelet doses (range 6-77, SD 15.18) and an average of 561.4 mL of RBC concentrate (range 0-2410, SD 541.1). As many as 23 patients (45.1%) did not require any RBC transfusions. CR was obtained in 32 (62.7%) and PR in 15 (29.4%) patients. Transplant related mortality was 5.9%. Projected overall survival from transplantation was 62% at 5 years, projected DFS was 67% at 5 years. In conclusion, BEAM myeloablative chemotherapy followed by autologous stem cell rescue induced high response rates, durable remissions and low transplant related mortality. Thus, the treatment proved to be both safe and effective even in this subgroup of heavily pretreated lymphoma patients.