Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0041-1740134
Original Article

Outcome of CBV (Carmustine, Cyclophosphamide, Etoposide) Conditioning Regimen for Autologous Stem Cell Transplant in Lymphoma: A Retrospective Study from a Tertiary Cancer Center in South India

Narendran Krishnamoorthi
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Bhanu Prakash
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Dhanraju KM
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Chinmaya Kumar Pani
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Malliha Ram
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Kalpana Rajesh
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Biswajit Dubashi
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Prasanth Ganesan 
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
,
Smita Kayal 
1   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Pondicherry, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background In autologous stem cell transplant (ASCT) for lymphomas, no standard conditioning regimen has been defined so far. Thus, the choice is guided by the center's familiarity and experience with a particular regimen.

Objective To determine the response, toxicity, and survival outcomes in lymphoma patients who underwent ASCT with CBV (cyclophosphamide, carmustine, and etoposide) conditioning regimen.

Materials and Methods Between January 2013 and May 2019, 45 consecutive lymphoma patients who had ASCT with CBV conditioning regimen were included in this retrospective study. CBV consisted of cyclophosphamide (1.5 g/m2/day × 4 days), carmustine (300 mg/m2 × 1 day), and etoposide (125 mg/m2 twice daily × 3 days). Baseline characteristics, pre transplant response, apheresis, post-transplant toxicities, post-transplant response, and survival outcomes were collected. Endpoints were toxicity, response, event-free survival (EFS), and overall survival (OS).

Results The median age was 30 (range: 6–64) years. Diagnosis was Hodgkin lymphoma (HL) in 26 (58%) and non-Hodgkin lymphoma (NHL) in 19 (42%). Forty-three patients (95%) had chemosensitive disease; 22(49%) in CR, and 21 (46%) in PR. The median CD34 was 2.95 × 106/kg (range: 0.9–9.56). The median time to neutrophil engraftment was 11 days (9–23) and 13 (8–36) days for platelets. All patients had febrile neutropenia, clinically and/or microbiologically documented infection was seen in 75% of patients. The most common grade 3/4 toxicities were mucositis (n = 4, 9%), diarrhea (n = 4, 9%), and nausea/vomiting (n = 2, 4%). The average days of hospitalization was 18 (range: 10–37). Day 100 mortality was 6.6% (n = 3). The median follow-up was 44.8 months. The median EFS for the entire cohort was 23.8 months; for HL, the median EFS was not reached, and for NHL, it was 7.97 months (95% confidence interval [CI]: 1.57–14.37). The median OS for the entire cohort and for HL was not reached; for NHL, it was 24.3 months (95% CI: 0.56–48.11).

Conclusion CBV conditioning regimen was well tolerated with low grade 3/4 toxicities and efficacy comparable to literature data.

Keywords

CBV conditioning regimen - autologous stem cell transplant - Hodgkin lymphoma - non-Hodgkin lymphoma

Authors' Contributions

Study conceptualization and methodology: SK, NK, BP, DK, CK, and BD. Data collection and analysis: NK, SK, BP, DK, CK, KR, and MR. Manuscript writing: NK, BP, SK, and PG. Review and editing: SK, BD, and PG. Final approval of manuscript: all authors.


Supplementary Material



Publication History

Article published online:
02 February 2022

© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Philip T, Biron P. High-dose chemotherapy and autologous bone marrow transplantation in diffuse intermediate- and high-grade non-Hodgkin lymphoma. Crit Rev Oncol Hematol 2002; 41 (02) 213-223
    CrossrefPubMedGoogle Scholar
  • 2 Sureda A, Bader P, Cesaro S. et al. Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplant 2015; 50 (08) 1037-1056
    CrossrefPubMedGoogle Scholar
  • 3 Salar A, Sierra J, Gandarillas M. et al; GEL/TAMO Spanish Cooperative Group. Autologous stem cell transplantation for clinically aggressive non-Hodgkin's lymphoma: the role of preparative regimens. Bone Marrow Transplant 2001; 27 (04) 405-412
    CrossrefPubMedGoogle Scholar
  • 4 Mounier N, Gisselbrecht C. Conditioning regimens before transplantation in patients with aggressive non-Hodgkin's lymphoma. Ann Oncol 1998; 9 (Suppl. 01) S15-S21
    CrossrefPubMedGoogle Scholar
  • 5 Philip T, Guglielmi C, Hagenbeek A. et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med 1995; 333 (23) 1540-1545
    CrossrefPubMedGoogle Scholar
  • 6 Isidori A, Christofides A, Visani G. Novel regimens prior to autologous stem cell transplantation for the management of adults with relapsed/refractory non-Hodgkin lymphoma and Hodgkin lymphoma: alternatives to BEAM conditioning. Leuk Lymphoma 2016; 57 (11) 2499-2509
    CrossrefPubMedGoogle Scholar
  • 7 Philip T, Chauvin F, Bron D. et al. PARMA international protocol: pilot study on 50 patients and preliminary analysis of the ongoing randomized study (62 patients). Ann Oncol 1991; 2 (Suppl. 01) 57-64
    CrossrefPubMedGoogle Scholar
  • 8 Rajamanickam D, Gokarn A, Gupta A. et al. LACE - an effective conditioning regimen for lymphoma patients undergoing autologous transplant- analysis of outcomes and prognostic factors. J Cancer Res Ther 2018; 14 (05) 926-933
    CrossrefPubMedGoogle Scholar
  • 9 Galieni P, Troiani E, Bigazzi C. et al. Modified BEAM as conditioning regimen for lymphoma patients undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2018; 53 (01) 91-93
    CrossrefPubMedGoogle Scholar
  • 10 Chen Y-B, Lane AA, Logan B. et al. Impact of conditioning regimen on outcomes for patients with lymphoma undergoing high-dose therapy with autologous hematopoietic cell transplantation. Biol Blood Marrow Transplant 2015; 21 (06) 1046-1053
    CrossrefPubMedGoogle Scholar
  • 11 Arranz R, Tomás JF, Gil-Fernández JJ. et al. Autologous stem cell transplantation (ASCT) for poor prognostic Hodgkin's disease (HD): comparative results with two CBV regimens and importance of disease status at transplant. Bone Marrow Transplant 1998; 21 (08) 779-786
    CrossrefPubMedGoogle Scholar
  • 12 Puig N, de la Rubia J, Remigia MJ. et al. Morbidity and transplant-related mortality of CBV and BEAM preparative regimens for patients with lymphoid malignancies undergoing autologous stem-cell transplantation. Leuk Lymphoma 2006; 47 (08) 1488-1494
    CrossrefPubMedGoogle Scholar
  • 13 Khattry N, Gupta A, Jain R. et al. LACE versus BEAM conditioning in relapsed and refractory lymphoma transplant: retrospective multicenter analysis of toxicity and efficacy. Int J Hematol 2016; 103 (03) 292-298
    CrossrefPubMedGoogle Scholar
  • 14 Shi Y, Liu P, Zhou S. et al. Comparison of CBV, BEAM and BEAC high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation in non-Hodgkin lymphoma: efficacy and toxicity. Asia Pac J Clin Oncol 2017; 13 (05) e423-e429
    CrossrefPubMedGoogle Scholar
  • 15 Sharma A, Kayal S, Iqbal S, Malik PS, Raina V. Comparison of BEAM vs. LEAM regimen in autologous transplant for lymphoma at AIIMS. Springerplus 2013; 2: 489
    CrossrefPubMedGoogle Scholar
  • 16 Harris RE, Termuhlen AM, Smith LM. et al. Autologous peripheral blood stem cell transplantation in children with refractory or relapsed lymphoma: results of Children's Oncology Group study A5962. Biol Blood Marrow Transplant 2011; 17 (02) 249-258
    CrossrefPubMedGoogle Scholar
  • 17 Colby C, McAfee SL, Finkelstein DM, Spitzer TR. Early vs delayed administration of G-CSF following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 1998; 21 (10) 1005-1010
    CrossrefPubMedGoogle Scholar
  • 18 de Azevedo AM, Nucci M, Maiolino A. et al. A randomized, multicenter study of G-CSF starting on day +1 vs day +5 after autologous peripheral blood progenitor cell transplantation. Bone Marrow Transplant 2002; 29 (09) 745-751
    CrossrefPubMedGoogle Scholar
  • 19 Valcárcel D, Sureda A. Graft failure. In: Carreras E, Dufour C, Mohty M, Kröger N. eds. The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies. 7th ed.. Springer; 2019: 307-313
    CrossrefGoogle Scholar
  • 20 Murray S. Engraftment. In: Maziarz RT, Slater SS. eds. Blood and Marrow Transplant Handbook: Comprehensive Guide for Patient Care. Springer International Publishing; 2015: 161-165
    CrossrefGoogle Scholar
  • 21 Maiolino A, Biasoli I, Lima J, Portugal AC, Pulcheri W, Nucci M. Engraftment syndrome following autologous hematopoietic stem cell transplantation: definition of diagnostic criteria. Bone Marrow Transplant 2003; 31 (05) 393-397
    CrossrefPubMedGoogle Scholar
  • 22 Bearman SI, Appelbaum FR, Buckner CD. et al. Regimen-related toxicity in patients undergoing bone marrow transplantation. J Clin Oncol 1988; 6 (10) 1562-1568
    CrossrefPubMedGoogle Scholar
  • 23 Common Terminology Criteria for Adverse Events (CTCAE) | Protocol Development | CTEP. Accessed October 18, 2021 at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm
    Google Scholar
  • 24 Dos Santos KB, Costa LJM, Bettarello G. et al. LEAM versus CBV for conditioning in autologous hematopoietic stem cell transplantation for lymphoma. Bone Marrow Transplant 2019; 54 (04) 625-628
    CrossrefPubMedGoogle Scholar
  • 25 Bishop MR, Dean RM, Steinberg SM. et al. Correlation of pretransplant and early post-transplant response assessment with outcomes after reduced-intensity allogeneic hematopoietic stem cell transplantation for non-Hodgkin's lymphoma. Cancer 2010; 116 (04) 852-862
    CrossrefPubMedGoogle Scholar
  • 26 Nieto Y, Popat U, Anderlini P. et al. Autologous stem cell transplantation for refractory or poor-risk relapsed Hodgkin's lymphoma: effect of the specific high-dose chemotherapy regimen on outcome. Biol Blood Marrow Transplant 2013; 19 (03) 410-417
    CrossrefPubMedGoogle Scholar