Pre-stem cell transplant BEAM versus FEAM for non-Hodgkin’s lymphoma

This study compared the safety and effectiveness of BEAM (carmustine, etoposide, cytarabine, melphalan) and FEAM (fotemustine instead of carmustine) chemotherapy regimens in patients with non-Hodgkin's lymphoma. This study concluded that these regimens are similarly effective, but FEAM was associated with more severe side effects.

Stem cell transplant (SCT) involves replacing the patient’s cancer cells with healthy stem cells. This procedure requires high-dose chemotherapy. BEAM is one type of pre-transplant regimen for lymphoma patients. However, carmustine has been associated with toxic lung side effects.

FEAM substitutes fotemustine for carmustine. Previous studies have shown that FEAM may be less toxic than BEAM. Whether FEAM is safer and more effective than BEAM for patients with non-Hodgkin's lymphoma remains under investigation.

This study involved 1038 patients. 30.1% of patients had diffuse large b-cell lymphoma. 12.5% had mantle cell lymphoma. 15.5% had indolent non-Hodgkin’s lymphoma (such as follicular lymphoma). 79.5% of all patients had stage 3 – 4 disease. Patients received BEAM (58.5%) or FEAM (41.5%) chemotherapy. The average follow-up period was 42 months.

91% (BEAM) and 88% (FEAM) of patients had a complete (disappearance of cancer) or partial (tumor shrinkage) response after 100 days of treatment. 22.6% (BEAM) and 23.7% (FEAM) of patients had a complete response after transplant.

For all patients, two-year overall survival (patients still alive 2 years later) was 83.9%. Two-year progression-free survival (patients alive without a return of disease) was 70.3%.

Overall, 71% of patients in both treatment groups reported severe or life-threatening side effects. FEAM-treated patients reported significantly more nausea and vomiting (17% compared to 12% with BEAM), diarrhea (28% compared to 21% with BEAM), and inflammation of mucous membranes (44% compared to 31% with BEAM). 

FEAM-treated patients were also significantly more likely to experience low white blood cell count with fever (6.3% compared to 1.5% with BEAM) and infections (11.4% compared to 4.9% with BEAM). These were life-threatening.

This study concluded that the BEAM and FEAM regimens are similarly effective. However, FEAM was associated with more severe side effects.

This study was retrospective, meaning it looked back in time to analyze data.