How effective is idarubicin-substituted BEAC (IEAC) as a conditioning regimen for patients with B-cell non-Hodgkin’s lymphoma undergoing ASCT?

This study compared the BEAC (BCNU, etoposide, cytarabine, and cyclophosphamide) and IEAC (idarubicin, etoposide, cytarabine, and cyclophosphamide) regimens before autologous stem cell transplantation (ASCT) in patients with relapsed/refractory (r/r) and aggressive B-cell non-Hodgkin lymphoma (NHL).

The study found that IEAC regimen was well tolerated and replacing BCNU (carmustine) with idarubicin could be an alternative when this drug is not available.

High-dose chemotherapy is the standard treatment for patients with aggressive NHL. ASCT is the standard treatment for relapsed (return of cancer) or refractory (cancer does not respond to treatment) aggressive NHL. The most commonly used conditioning regimens preparing NHL patients for ASCT are BEAM (BCNU, etoposide, cytarabine, and melphalan), BEAC (BCNU, etoposide, cytarabine, and cyclophosphamide), and CBV (carmustine, cyclophosphamide, and etoposide). 

New conditioning regimens are being investigated to improve the outcomes of patients with NHL. Some drugs of the commonly used conditioning regimens such as BCNU are often in shortage of supply. Idarubicin is not a popular treatment used in conditioning regimens. It is important to evaluate if idarubicine can replace BCNU in the BEAC regimen (IEAC) in patients with r/r aggressive B-cell NHL.

This study recruited 72 patients with invasive r/r B-cell NHL. These patients were treated with either IEAC (40) or BEAC (32) as conditioning regimens. After this, patients underwent ASCT in which damaged lymphoma cells were replaced with healthy stem cells from the patients themselves. The average follow-up time was 31 months.

All patients achieved successful engraftment after ASCT (when stem cells start producing healthy blood cells). There was no difference in engraftment time between the IEAC and BEAC groups. The average overall survival (OS) was longer in the IEAC group (33 months) compared to the BEAC group (30 months). The average survival without cancer worsening was also longer in the IEAC group (23 months) compared to the BEAC group (18 months). 

The most common side effects reported in both treatment groups included fever, nausea and vomiting, tissue swelling in the mouth, and heart damage. The most commonly reported side effect in the IEAC group was fever. However, there were no significant differences between both groups.

The authors outlined that the IEAC regimen was effective and well tolerated in patients with aggressive r/r NHL. The authors suggested that the replacement of BCNU with idarubicin could be an alternative treatment regimen when this drug is not available.

This study recruited a small number of patients from China. These results need to be verified in clinical trials that recruit a larger number of patients with different ethnicities.