BEAC or BEAM Chemotherapy Followed by Autologous Stem Cell Transplantation in Non-Hodgkin’s Lymphoma Patients: Comparative Analysis on Efficacy and Toxicity.

Background: Non-Hodgkin’s lymphoma (NHL) is the major indication of high dose chemotherapy (HDC) followed by autologous stem cell transplantation (ASCT). However, little is known on the comparative efficacy and toxicity of various HDC regimens.

Aims: This study aimed to compare the efficacy and toxicity of BEAC and BEAM regimen.

Methods: Between April 1994 and February 2005, 97 NHL patients were received HDC with BEAC (N=69) or BEAM (N=28) followed by ASCT at Asan Medical Center. We matched one patient received BEAM with two patients received BEAC who has same International Prognostic Index (IPI). Thus total 84 patients (56 in BEAC group and 28 in BEAM group) were analyzed.

Results: Of 84 patients, 55 (65.5%) were male, 29 (34.5%) were female and median age was 40.5 (15–65) years. Baseline characteristics such as age, sex, disease status at ASCT, histology, stage at ASCT, IPI were not different between two groups. Time to neutrophil engraftment (WBC>0.5′10⁹/mm³) was significantly longer in BEAC group (14.5days) than in BEAM group (11.0days, p=0.002). Total amount of RBC transfusion was more in BEAC group than in BEAM group (6.5 units vs. 3.7 units, p=0.037). Time to platelet engraftment (platelet>20′10⁹/mm³) and total amount of platelet transfusion were different between two groups. Patients received BEAM had more frequent WHO grade ≥ 2 diarrhea than those received BEAC (46.4% vs. 19.6%, p=0.010). But, other clinically important toxicity such as mucositis, nausea/vomiting, bleeding were not different between two groups. In addition, neutropenic fever and documented infection were not different between two groups. Two year overall survival (OS) rate was 30% in BEAC group and 66% in BEAM group. Two year event free survival (EFS) rate was 34% in BEAC group and 61% in BEAM group. Both OS and EFS was significantly superior in BEAM group than in BEAC group (p=0.049, p=0.032, respectively).

Summary/Conclusions: BEAM appears to be a superior HDC regimen in the aspect of OS and EFS than BEAC while regimen related toxicity is similar except more frequent diarrhea in BEAM.