Evaluating BendaEAM chemotherapy before stem cell transplantation for relapsed lymphoma

This study evaluated the effectiveness and safety of the BendaEAM (bendamustine, etoposide, cytarabine, melphalan) in patients with lymphoma undergoing autologous stem cell transplantation (auto-SCT). This study concluded that BendaEAM is a feasible option for these patients, with minimal side effects.

High-dose chemotherapy followed by auto-SCT is the standard of care in patients with relapsed lymphoma. Auto-SCT involves replacing the patient’s cancer cells with his or her own healthy stem cells. To collect these healthy cells, high-dose chemotherapy is needed to get rid of any remaining cancer cells. 

The most common chemotherapy regimen used before auto-SCT is BEAM (carmustine, etoposide, cytarabine, melphalan). However, carmustine (Bicnu) is associated with side effects in the lungs and increased mortality. Whether replacing carmustine with bendamustine (Treanda) in this regimen improves the outcomes of patients with NHL remains unclear.

This study involved 41 patients with lymphoma. 78% of patients had non-Hodgkin’s lymphoma (NHL) and 22% had Hodgkin’s Disease (HD). The most common subtypes were diffuse large B-cell lymphoma (26.8%) and mantle cell lymphoma (24.4%). Patients received BendaEAM (bendamustine substituted for carmustine) before auto-SCT. Patients were followed-up for an average of 55 months. 

At follow-up, 56% of patients achieved a complete response (disappearance of all signs of cancer). 44% of patients experienced disease progression (tumor grows or spreads) at an average of 8.5 months after the transplant. 

The 2-year progression-free survival (PFS; patients still alive 2 years later without disease progression) was 58.6%. The 2-year overall survival (OS; patients still alive 2 years later) was 78.0%. At 4 years, these rates were 55.6% (PFS) and 72.6% (OS). 

The most common severe to life-threatening side effects reported were diarrhea (24%), infections (22%), and low white blood cell count with fever (14%). 14.6% of patients experienced kidney damage.

This study concluded that BendaEAM is a promising pre-transplant regimen for patients with lymphoma, with minimal side effects.

The patient population in this study was small. Larger studies are needed to establish the role of the BendaEAM regimen in patients with relapsed lymphoma.