Tsang ES, et al. ASH 2017:3291

Comparative effectiveness of high-dose Benda-EAM versus BEAM in patients with R/R classical HL undergoing ASCT

Background

The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) is a frequently used conditioning regimen prior to autologous stem cell transplantation (ASCT) for patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). However, the carmustine component of this regimen is associated with notable toxicities, including interstitial pneumonitis. The substitution of carmustine with bendamustine (Benda-EAM) has been shown to be safe and effective in a phase I/II study1; however, Benda-EAM has not been directly compared to BEAM. At the 2017 ASH Annual Meeting, a matched analysis was presented that compared clinical outcomes and toxicities of the Benda-EAM and BEAM regimens prior to ASCT in patients with R/R HL.2

Study design

  • A retrospective, multicentre, cohort study was conducted in the Hematology and Stem Cell Transplant Center, AORMN (Azienda Ospedaliera Ospedali Riuniti Marche Nord) in Pesaro, Italy and the British Columbia Cancer Agency in Vancouver, Canada.
  • Benda-EAM patients were matched 1:2 to BEAM patients on the basis of two predetermined factors:
    • Relapsed versus refractory disease after first-line therapy; and
    • Chemosensitivity to salvage therapy immediately prior to ASCT.
  • Patient characteristics, treatments, toxicities, and outcomes between both cohorts were compared.

Key findings

Baseline characteristics and disposition

  • Twenty-six patients treated with Benda-EAM were matched to 52 patients treated with BEAM.
  • Due to small numbers, additional matching factors could not be introduced.
  • BEAM patients received fewer treatments, with a median of one (range: 0–2) line of therapy versus two (range: 1–5) for Benda-EAM.
  • Additional baseline and treatment characteristics are described in Table 1.

Table 1. Baseline and treatment characteristics

Efficacy

  • Median post-ASCT follow-up was 2.1 years in the Benda-EAM arm and 3.9 years in the BEAM arm.
  • Two-year and four-year overall survival (OS) rates were similar between treatment arms. (Figure 1)
  • Two-year progression-free survival (PFS) rates were also similar between groups. (Figure 2)

Figure 1. Post-ASCT overall survival

Figure 2. Post-ASCT progression-free survival

Safety

  • Common adverse events are described in Table 2.
  • There have been three post–Benda-EAM deaths (all due to HL) and 17 post-BEAM deaths (16 HL, one unrelated), with no treatment-related deaths.

Table 2. Common adverse events

Key conclusions

  • Post-ASCT survival outcomes were similar between patients receiving Benda-EAM versus BEAM, despite patient and disease characteristic differences between groups.
  • Benda-EAM may be a reasonable alternative to BEAM in select patients with R/R HL.

References: 1. Visani G, Malerba L, Stefani PM, et al. BeEAM (bendamustine, etoposide, cytarabine, melphalan) before autologous stem cell transplantation is safe and effective for resistant/relapsed lymphoma patients. Blood 2011;118(12):3419–25. 2. Tsang ES, Villa D, Loscocco F, et al. Comparative effectiveness of high-dose Be-EAM vs. BEAM in patients with relapsed/refractory classical Hodgkin lymphoma undergoing autologous stem cell transplantation. ASH Annual Meeting Abstracts 2017:3291.