Baskent University Adana Adult Bone Marrow Transplantation Center, Adana, Turkey.
Baskent University Adana Adult Bone Marrow Transplantation Center, Adana, Turkey.
Clin Lymphoma Myeloma Leuk. 2020 Oct;20(10):652-660. doi: 10.1016/j.clml.2020.05.009. Epub 2020 May 21.
Approximately half of patients with relapsed chemosensitive disease achieve robust responses with BEAM (BCNU, etoposide, cytarabine, and melphalan) and autologous stem cell rescue. The scarcity of comparative studies further limits alternative treatment protocols, such as the MITO/MEL (mitoxantrone, melphalan) protocol.
In this retrospective multicenter study, we compared the BEAM and MITO/MEL regimens used before autologous hematopoietic stem cell transplantation (ASCT) in terms of efficacy and side effects in patients with Hodgkin lymphoma. Data met international accreditation rules. Before ASCT, 108 patients received the MITO/MEL, and 34 patients received the BEAM.
The median follow-up time was 36 months in the MITO/MEL group (range, 3-178) and 23 months in the BEAM group (range, 4-99). After ASCT, the 3-year expected overall survival and disease-free survival rates were 86.1% and 86.1% for the MITO/MEL group and 91.3% and 76.5% for the BEAM group, respectively. Although 50% of patients developed febrile neutropenia attacks in the MITO/MEL group, this rate was 91.1% in the BEAM group. The grade II and higher rates of hepatic, renal, gastrointestinal, and cardiac toxicities were similar in both groups. However, the rate of pulmonary toxicity was determined to be 1.9% in the MITO/MEL group and 29.4% in the BEAM group (P < .001).
The MITO/MEL conditioning regimen seems to be as effective as the BEAM regimen but has better tolerability in terms of pulmonary toxicity and may be used as an alternative option if necessary, depending on the comorbidity status of the patient.
约一半缓解期敏感疾病的患者在接受 BEAM（卡氮芥、依托泊苷、阿糖胞苷和马法兰）和自体干细胞解救后可获得显著缓解。缺乏对照研究进一步限制了其他治疗方案，如 MITO/MEL（米托蒽醌、马法兰）方案。
在这项回顾性多中心研究中，我们比较了接受自体造血干细胞移植（ASCT）前应用 BEAM 和 MITO/MEL 方案治疗霍奇金淋巴瘤患者的疗效和副作用。数据符合国际认证规则。在 ASCT 前，108 例患者接受 MITO/MEL 方案，34 例患者接受 BEAM 方案。
MITO/MEL 组的中位随访时间为 36 个月（范围 3-178），BEAM 组为 23 个月（范围 4-99）。ASCT 后，MITO/MEL 组 3 年预期总生存率和无病生存率分别为 86.1%和 86.1%，BEAM 组分别为 91.3%和 76.5%。虽然 MITO/MEL 组有 50%的患者发生发热性中性粒细胞减少症，但 BEAM 组这一比例为 91.1%。两组肝、肾、胃肠道和心脏毒性的 2 级及以上发生率相似。然而，MITO/MEL 组的肺毒性发生率为 1.9%，BEAM 组为 29.4%（P<0.001）。
MITO/MEL 预处理方案似乎与 BEAM 方案同样有效，但在肺毒性方面耐受性更好，如果需要，可根据患者的合并症情况作为替代选择。
