A Comparison of the Conditioning Regimens BEAM and FEAM for Autologous Hematopoietic Stem Cell Transplantation in Lymphoma: An Observational Study on 1038 Patients From Fondazione Italiana Linfomi

J Olivieri, F Mosna, M Pelosini, A Fama, S Rattotti, M Giannoccaro, G Carli, MC Tisi, S Ferrero, N Sgherza, AM Mazzone, D Marino, T Calimeri, G Loseto, F Saraceni, G Tomei, S Sica, G Perali, K Codeluppi, A BillioA Olivieri, E Orciuolo, R Matera, PM Stefani, C Borghero, P Ghione, N Cascavilla, F Lanza, P Chiusolo, S Finotto, I Federici, F Gherlinzoni, R Centurioni, R Fanin, F Zaja, on behalf of the Fondazione Italiana Linfomi Postgraduate Master Course

Research output: Contribution to journalArticle

Abstract

BEAM (carmustine [bis-chloroethylnitrosourea (BCNU)]-etoposide-cytarabine-melphalan) chemotherapy is the standard conditioning regimen for autologous stem cell transplantation (ASCT) in lymphomas. Owing to BCNU shortages, many centers switched to fotemustine-substituted BEAM (FEAM), lacking proof of equivalence. We conducted a retrospective cohort study in 18 Italian centers to compare the safety and efficacy of BEAM and FEAM regimens for ASCT in lymphomas performed from 2008 to 2015. We enrolled 1038 patients (BEAM = 607, FEAM = 431), of which 27% had Hodgkin lymphoma (HL), 14% indolent non-Hodgkin lymphoma (NHL), and 59% aggressive NHL. Baseline characteristics including age, sex, stage, B-symptoms, extranodal involvement, previous treatments, response before ASCT, and overall conditioning intensity were well balanced between BEAM and FEAM; notable exceptions were median ASCT year (BEAM = 2011 versus FEAM = 2013, P <.001), Sorror score ≥3 (BEAM = 15% versus FEAM = 10%, P = .017), and radiotherapy use (BEAM = 18% versus FEAM = 10%, P <.001). FEAM conditioning resulted in higher rates of gastrointestinal and infectious toxicities, including severe oral mucositis grade ≥3 (BEAM = 31% versus FEAM = 44%, P <.001), and sepsis from Gram-negative bacteria (mean isolates/patient: BEAM = .1 versus FEAM = .19, P <.001). Response status at day 100 post-ASCT (overall response: BEAM = 91% versus FEAM = 88%, P = .42), 2-year overall survival (83.9%; 95% confidence interval [CI], 81.5% to 86.1%) and progression-free survival (70.3%; 95% CI, 67.4% to 73.1%) were not different in the two groups. Mortality from infection was higher in the FEAM group (subhazard ratio, 1.99; 95% CI, 1.02 to 3.88; P = .04). BEAM and FEAM do not appear different in terms of survival and disease control. However, due to concerns of higher toxicity, fotemustine substitution in BEAM does not seem justified, if not for easier supply. © 2018 The American Society for Blood and Marrow Transplantation
Original languageEnglish
Pages (from-to)1814-1822
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number9
DOIs
Publication statusPublished - 2018

Fingerprint

fotemustine
Carmustine
Melphalan
Hematopoietic Stem Cell Transplantation
Cytarabine
Etoposide
Observational Studies
Lymphoma
Stem Cell Transplantation

Cite this

A Comparison of the Conditioning Regimens BEAM and FEAM for Autologous Hematopoietic Stem Cell Transplantation in Lymphoma: An Observational Study on 1038 Patients From Fondazione Italiana Linfomi. / Olivieri, J; Mosna, F; Pelosini, M; Fama, A; Rattotti, S; Giannoccaro, M; Carli, G; Tisi, MC; Ferrero, S; Sgherza, N; Mazzone, AM; Marino, D; Calimeri, T; Loseto, G; Saraceni, F; Tomei, G; Sica, S; Perali, G; Codeluppi, K; Billio, A; Olivieri, A; Orciuolo, E; Matera, R; Stefani, PM; Borghero, C; Ghione, P; Cascavilla, N; Lanza, F; Chiusolo, P; Finotto, S; Federici, I; Gherlinzoni, F; Centurioni, R; Fanin, R; Zaja, F; Course, on behalf of the Fondazione Italiana Linfomi Postgraduate Master.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 9, 2018, p. 1814-1822.

Research output: Contribution to journalArticle

Olivieri, J, Mosna, F, Pelosini, M, Fama, A, Rattotti, S, Giannoccaro, M, Carli, G, Tisi, MC, Ferrero, S, Sgherza, N, Mazzone, AM, Marino, D, Calimeri, T, Loseto, G, Saraceni, F, Tomei, G, Sica, S, Perali, G, Codeluppi, K, Billio, A, Olivieri, A, Orciuolo, E, Matera, R, Stefani, PM, Borghero, C, Ghione, P, Cascavilla, N, Lanza, F, Chiusolo, P, Finotto, S, Federici, I, Gherlinzoni, F, Centurioni, R, Fanin, R, Zaja, F & Course, OBOTFILPM 2018, 'A Comparison of the Conditioning Regimens BEAM and FEAM for Autologous Hematopoietic Stem Cell Transplantation in Lymphoma: An Observational Study on 1038 Patients From Fondazione Italiana Linfomi', Biology of Blood and Marrow Transplantation, vol. 24, no. 9, pp. 1814-1822. https://doi.org/10.1016/j.bbmt.2018.05.018
Olivieri, J ; Mosna, F ; Pelosini, M ; Fama, A ; Rattotti, S ; Giannoccaro, M ; Carli, G ; Tisi, MC ; Ferrero, S ; Sgherza, N ; Mazzone, AM ; Marino, D ; Calimeri, T ; Loseto, G ; Saraceni, F ; Tomei, G ; Sica, S ; Perali, G ; Codeluppi, K ; Billio, A ; Olivieri, A ; Orciuolo, E ; Matera, R ; Stefani, PM ; Borghero, C ; Ghione, P ; Cascavilla, N ; Lanza, F ; Chiusolo, P ; Finotto, S ; Federici, I ; Gherlinzoni, F ; Centurioni, R ; Fanin, R ; Zaja, F ; Course, on behalf of the Fondazione Italiana Linfomi Postgraduate Master. / A Comparison of the Conditioning Regimens BEAM and FEAM for Autologous Hematopoietic Stem Cell Transplantation in Lymphoma: An Observational Study on 1038 Patients From Fondazione Italiana Linfomi. In: Biology of Blood and Marrow Transplantation. 2018 ; Vol. 24, No. 9. pp. 1814-1822.
@article{d64e6e5d340343c9a8e4f64bf7351df2,
title = "A Comparison of the Conditioning Regimens BEAM and FEAM for Autologous Hematopoietic Stem Cell Transplantation in Lymphoma: An Observational Study on 1038 Patients From Fondazione Italiana Linfomi",
abstract = "BEAM (carmustine [bis-chloroethylnitrosourea (BCNU)]-etoposide-cytarabine-melphalan) chemotherapy is the standard conditioning regimen for autologous stem cell transplantation (ASCT) in lymphomas. Owing to BCNU shortages, many centers switched to fotemustine-substituted BEAM (FEAM), lacking proof of equivalence. We conducted a retrospective cohort study in 18 Italian centers to compare the safety and efficacy of BEAM and FEAM regimens for ASCT in lymphomas performed from 2008 to 2015. We enrolled 1038 patients (BEAM = 607, FEAM = 431), of which 27{\%} had Hodgkin lymphoma (HL), 14{\%} indolent non-Hodgkin lymphoma (NHL), and 59{\%} aggressive NHL. Baseline characteristics including age, sex, stage, B-symptoms, extranodal involvement, previous treatments, response before ASCT, and overall conditioning intensity were well balanced between BEAM and FEAM; notable exceptions were median ASCT year (BEAM = 2011 versus FEAM = 2013, P <.001), Sorror score ≥3 (BEAM = 15{\%} versus FEAM = 10{\%}, P = .017), and radiotherapy use (BEAM = 18{\%} versus FEAM = 10{\%}, P <.001). FEAM conditioning resulted in higher rates of gastrointestinal and infectious toxicities, including severe oral mucositis grade ≥3 (BEAM = 31{\%} versus FEAM = 44{\%}, P <.001), and sepsis from Gram-negative bacteria (mean isolates/patient: BEAM = .1 versus FEAM = .19, P <.001). Response status at day 100 post-ASCT (overall response: BEAM = 91{\%} versus FEAM = 88{\%}, P = .42), 2-year overall survival (83.9{\%}; 95{\%} confidence interval [CI], 81.5{\%} to 86.1{\%}) and progression-free survival (70.3{\%}; 95{\%} CI, 67.4{\%} to 73.1{\%}) were not different in the two groups. Mortality from infection was higher in the FEAM group (subhazard ratio, 1.99; 95{\%} CI, 1.02 to 3.88; P = .04). BEAM and FEAM do not appear different in terms of survival and disease control. However, due to concerns of higher toxicity, fotemustine substitution in BEAM does not seem justified, if not for easier supply. {\circledC} 2018 The American Society for Blood and Marrow Transplantation",
author = "J Olivieri and F Mosna and M Pelosini and A Fama and S Rattotti and M Giannoccaro and G Carli and MC Tisi and S Ferrero and N Sgherza and AM Mazzone and D Marino and T Calimeri and G Loseto and F Saraceni and G Tomei and S Sica and G Perali and K Codeluppi and A Billio and A Olivieri and E Orciuolo and R Matera and PM Stefani and C Borghero and P Ghione and N Cascavilla and F Lanza and P Chiusolo and S Finotto and I Federici and F Gherlinzoni and R Centurioni and R Fanin and F Zaja and Course, {on behalf of the Fondazione Italiana Linfomi Postgraduate Master}",
year = "2018",
doi = "10.1016/j.bbmt.2018.05.018",
language = "English",
volume = "24",
pages = "1814--1822",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "9",

}

TY - JOUR

T1 - A Comparison of the Conditioning Regimens BEAM and FEAM for Autologous Hematopoietic Stem Cell Transplantation in Lymphoma: An Observational Study on 1038 Patients From Fondazione Italiana Linfomi

AU - Olivieri, J

AU - Mosna, F

AU - Pelosini, M

AU - Fama, A

AU - Rattotti, S

AU - Giannoccaro, M

AU - Carli, G

AU - Tisi, MC

AU - Ferrero, S

AU - Sgherza, N

AU - Mazzone, AM

AU - Marino, D

AU - Calimeri, T

AU - Loseto, G

AU - Saraceni, F

AU - Tomei, G

AU - Sica, S

AU - Perali, G

AU - Codeluppi, K

AU - Billio, A

AU - Olivieri, A

AU - Orciuolo, E

AU - Matera, R

AU - Stefani, PM

AU - Borghero, C

AU - Ghione, P

AU - Cascavilla, N

AU - Lanza, F

AU - Chiusolo, P

AU - Finotto, S

AU - Federici, I

AU - Gherlinzoni, F

AU - Centurioni, R

AU - Fanin, R

AU - Zaja, F

AU - Course, on behalf of the Fondazione Italiana Linfomi Postgraduate Master

PY - 2018

Y1 - 2018

N2 - BEAM (carmustine [bis-chloroethylnitrosourea (BCNU)]-etoposide-cytarabine-melphalan) chemotherapy is the standard conditioning regimen for autologous stem cell transplantation (ASCT) in lymphomas. Owing to BCNU shortages, many centers switched to fotemustine-substituted BEAM (FEAM), lacking proof of equivalence. We conducted a retrospective cohort study in 18 Italian centers to compare the safety and efficacy of BEAM and FEAM regimens for ASCT in lymphomas performed from 2008 to 2015. We enrolled 1038 patients (BEAM = 607, FEAM = 431), of which 27% had Hodgkin lymphoma (HL), 14% indolent non-Hodgkin lymphoma (NHL), and 59% aggressive NHL. Baseline characteristics including age, sex, stage, B-symptoms, extranodal involvement, previous treatments, response before ASCT, and overall conditioning intensity were well balanced between BEAM and FEAM; notable exceptions were median ASCT year (BEAM = 2011 versus FEAM = 2013, P <.001), Sorror score ≥3 (BEAM = 15% versus FEAM = 10%, P = .017), and radiotherapy use (BEAM = 18% versus FEAM = 10%, P <.001). FEAM conditioning resulted in higher rates of gastrointestinal and infectious toxicities, including severe oral mucositis grade ≥3 (BEAM = 31% versus FEAM = 44%, P <.001), and sepsis from Gram-negative bacteria (mean isolates/patient: BEAM = .1 versus FEAM = .19, P <.001). Response status at day 100 post-ASCT (overall response: BEAM = 91% versus FEAM = 88%, P = .42), 2-year overall survival (83.9%; 95% confidence interval [CI], 81.5% to 86.1%) and progression-free survival (70.3%; 95% CI, 67.4% to 73.1%) were not different in the two groups. Mortality from infection was higher in the FEAM group (subhazard ratio, 1.99; 95% CI, 1.02 to 3.88; P = .04). BEAM and FEAM do not appear different in terms of survival and disease control. However, due to concerns of higher toxicity, fotemustine substitution in BEAM does not seem justified, if not for easier supply. © 2018 The American Society for Blood and Marrow Transplantation

AB - BEAM (carmustine [bis-chloroethylnitrosourea (BCNU)]-etoposide-cytarabine-melphalan) chemotherapy is the standard conditioning regimen for autologous stem cell transplantation (ASCT) in lymphomas. Owing to BCNU shortages, many centers switched to fotemustine-substituted BEAM (FEAM), lacking proof of equivalence. We conducted a retrospective cohort study in 18 Italian centers to compare the safety and efficacy of BEAM and FEAM regimens for ASCT in lymphomas performed from 2008 to 2015. We enrolled 1038 patients (BEAM = 607, FEAM = 431), of which 27% had Hodgkin lymphoma (HL), 14% indolent non-Hodgkin lymphoma (NHL), and 59% aggressive NHL. Baseline characteristics including age, sex, stage, B-symptoms, extranodal involvement, previous treatments, response before ASCT, and overall conditioning intensity were well balanced between BEAM and FEAM; notable exceptions were median ASCT year (BEAM = 2011 versus FEAM = 2013, P <.001), Sorror score ≥3 (BEAM = 15% versus FEAM = 10%, P = .017), and radiotherapy use (BEAM = 18% versus FEAM = 10%, P <.001). FEAM conditioning resulted in higher rates of gastrointestinal and infectious toxicities, including severe oral mucositis grade ≥3 (BEAM = 31% versus FEAM = 44%, P <.001), and sepsis from Gram-negative bacteria (mean isolates/patient: BEAM = .1 versus FEAM = .19, P <.001). Response status at day 100 post-ASCT (overall response: BEAM = 91% versus FEAM = 88%, P = .42), 2-year overall survival (83.9%; 95% confidence interval [CI], 81.5% to 86.1%) and progression-free survival (70.3%; 95% CI, 67.4% to 73.1%) were not different in the two groups. Mortality from infection was higher in the FEAM group (subhazard ratio, 1.99; 95% CI, 1.02 to 3.88; P = .04). BEAM and FEAM do not appear different in terms of survival and disease control. However, due to concerns of higher toxicity, fotemustine substitution in BEAM does not seem justified, if not for easier supply. © 2018 The American Society for Blood and Marrow Transplantation

U2 - 10.1016/j.bbmt.2018.05.018

DO - 10.1016/j.bbmt.2018.05.018

M3 - Article

VL - 24

SP - 1814

EP - 1822

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 9

ER -