BeEAM vs. BEAM: Evaluating Conditioning Regimens for Relapsed or Refractory DLBCL Autologous Stem Cell Transplantation

Abstract

Abstract Purpose To evaluate whether BeEAM can be used as an alternative to BEAM for autologous hematopoietic stem cell transplantation (ASCT) of relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Methods To retrospectively analyze the data of 60 patients with relapsed or refractory DLBCL who underwent ASCT from January 2018 to June 2023 in our center, including 30 patients in the BeEAM group and 30 patients in the BEAM group. The time to hematopoietic reconstitution, treatment-related adverse events, hospitalization days, hospitalization costs, and survival benefit were compared between the two groups. Results There was no statistically significant difference in the clinical characteristics of the enrolled patients. The median number of CD34 + cells infused back in the BeEAM and BEAM groups was 5.17×106/kg and 5.06×106/kg, respectively, which was not statistically different (p = 0.8829). The median time to neutrophil implantation in the BeEAM group and the BEAM group was 10.2 days and 10.27 days, respectively (p = 0.8253); median time to platelet implantation was 13.23 and 12.87 days, respectively (p = 0.7671). There was no statistical difference in the time to hematopoietic reconstitution between the two groups. The median hospitalization time in the BeEAM and BEAM groups was 30.37 and 30.57 days, respectively (p = 0.9060); and the median hospitalization cost in the two groups was RMB 83,425 and RMB 96,235, respectively (p = 0.0560). There existed a numerical advantage in hospitalization cost in the BeEAM group, which was economical. The most common hematologic adverse events were grade ≥ 3 neutropenia and thrombocytopenia, which showed a high degree of consistency in incidence between the two groups. Most non-hematologic adverse events were ≤ grade 2 and included mucositis, nausea, vomiting, diarrhea, elevated aminotransferases, elevated bilirubin, elevated creatinine, and granulomatous deficiencies with fever, with no statistically significant difference in the incidence of these events between the two groups. Median overall survival was not reached in either group, with a predicted 5-year OS of 72.5% in the BeEAM group and 60% in the BEAM group (p = 0.5872). The 5-year PFS was 25% and 20% in the two groups, respectively (p = 0.6804). There was no statistical difference in survival benefit between the two conditioning regimens. Conclusion BeEAM as a conditioning regimen for relapsed or refractory DLBCL has a desirable safety profile and is well tolerated, with hematopoietic reconstitution time, hospitalization days, hospitalization costs, and survival benefit not inferior to that of BEAM. The BeEAM regimen is economically with numerically superior hospitalization costs and can be used as an alternative to BEAM.