BEAM versus BEAC high-dose chemotherapy for patients with non-Hodgkin’s lymphoma

This study evaluated the outcomes of two high-dose chemotherapy regimens for patients with non-Hodgkin’s lymphoma (NHL) before autologous stem cell transplantation (ASCT). This study concluded that the outcomes were similar between both regimens.

High-dose chemotherapy is typically used before ASCT to get rid of any remaining cancer cells. This type of chemotherapy is called a conditioning regimen. One of the most commonly used regimens is BEAM (carmustine, etoposide, cytarabine, melphalan). However, due to shortages of melphalan (Alkeran), cyclophosphamide (Cytoxan) is instead used in the BEAC regimen.

However, high-dose cyclophosphamide is associated with side effects. Previous studies have suggested that BEAC may be toxic to the heart. The safety of BEAC as a conditioning regimen for patients with NHL remains under investigation.

This study involved the records of 21,540 patients with NHL. This analysis compared 383 BEAC-treated patients to 766 BEAM-treated patients. Patients were followed-up for an average of 15 to 28 months.

At the time of transplant, 51.2% of patients in each treatment group had a disappearance of all signs of cancer. 2-year progression-free survival (patients still alive 2 years later without tumor growth or spread) was similar between BEAC-treated and BEAM-treated patients (63% vs. 64%). 2-year overall survival (patients still alive 2 years later) was also similar between both groups (78% vs. 77%).

The rates of relapse at 1 year were similar between the BEAC group and the BEAM group (24% vs. 23%). At 2 years, this rate was 32% vs. 33%.

Overall, 25 (BEAC) versus 34 (BEAM) cases of non-relapse mortality (death not due to cancer recurrence or progression; NRM) were reported. The most common cause was infection (5 cases vs. 7 cases).

This study concluded that patient outcomes were similar between BEAM and BEAC. The authors suggest that BEAC is a safe conditioning regimen for patients with NHL.

This study was retrospective, meaning it looked back in time to analyze data. More studies are needed to confirm these results. Studies of heart function in patients receiving BEAC conditioning are needed.