Comparing BEAM to MITO/MEL regimens before autologous hematopoietic stem cell transplantation in patients with Hodgkin lymphoma.

The authors compared the BEAM (BCNU, etoposide, cytarabine, and melphalan) and MITO/MEL (mitoxantrone, melphalan) regimens before autologous stem cell transplantation (ASCT) in patients with Hodgkin lymphoma (HL). The study found that both regimens were similarly effective with fewer lung side effects with MITO/MEL. 

ASCT is shown to provide only the advantage of disease-free survival (DFS) in patients with refractory/relapsed HL. DFS is the length of time after primary treatment for a cancer ends that the patient survives without any signs or symptoms of that cancer. ASCT uses healthy blood stem cells from the patient's own body to replace cancerous cells destroyed by chemotherapy.

The most commonly used regimen preparing patients for ASCT is BEAM. However, lung side effects are an issue of this regimen. Other studies have shown that the MITO/MEL regimen has successfully been used for lymphomas as a regimen preparing patients for ASCT. These studies suggest that MITO/MEL is well tolerated and effective for both HL and non-HL. However, there have been few studies explaining and comparing both regimens in patients with relapsed HL. 

This study enrolled 142 adult patients with relapsed HL undergoing ASCT. MITO/MEL was given to 108 patients, and BEAM to 34 patients before ASCT. The average follow-up period was 36 months for the MITO/MEL group and 23 months for the BEAM group.

Before ASCT, 66.7% of patients in the MITO/MEL group and 61.8% in the BEAM group had complete remission. Complete remission means that all signs of cancer are gone. The average number of days it took for healthy blood cells to successfully grow after ASCT was 12 in the MITO/MEL group and 10 in the BEAM group.

The expected 1-year overall survival rates were 95.3% in the MITO/MEL group and 100% in the BEAM group. The rate of relapse after 1 year was similar between the MITO/MEL (10.1%) and BEAM (8.8%) groups. DFS after 1 year was also similar between the MITO/MEL (89.6%) and BEAM (89.8%) groups. DFS after 3 years was 86.1% in the MITO/MEL group and 76.5% in the BEAM group.

Low levels of white blood cells with fever was a common side effect, reported in 50% of the MITO/MEL group and 91% of the BEAM group. Life-threatening generalized infection was reported in 5% of the MITO/MEL group and 12% of the BEAM group. Lung and liver side effects were significantly more common in the BEAM group compared to the MITO/MEL group. 

This study showed that the MITO/MEL conditioning regimen has similar effectiveness to the BEAM regimen before ASCT, with fewer side effects in patients with relapsed HL.

There was a lower number of patients and a shorter follow-up in the BEAM group than in the MITO/MEL group. This may have influenced the results.