Abstract
In many stem cell transplant centres, BCNU, etoposide, cytarabine and melphalan (BEAM) high-dose chemotherapy (HDCT) has been replaced by the more economic and available bendamustine, etoposide, cytarabine, melphalan (BeEAM) regimen. However, there is a paucity of information on the efficacy and safety of BeEAM HDCT. We describe our experience with BeEAM HDCT in terms of safety, efficacy and cost-savings. We compare overall and progression-free survival to a cohort of patients previously transplanted at our institution with the older BEAM regimen. We performed a retrospective chart review of 41 lymphoma patients undergoing BeEAM HDCT at the Royal University Hospital in Saskatoon, Saskatchewan between 2015 and 2019 to elicit regimen safety in the first 100 days post-transplant. Furthermore, we calculated overall and progression-free survival and constructed corresponding Kaplan–Meier curves, comparing the results to a historical cohort of BEAM patients (n = 86). Finally, we conducted an economic analysis using the financials available at our centre’s pharmacy. With regards to BeEAM HDCT, we report a 100-day transplant-related mortality of 2.4%. Additionally, we report acceptable rates of typhlitis (27%), grade III–IV mucositis (4.9%) and grade III–IV nephrotoxicity (2.4%). In terms of overall and progression-free survival, we found no statistical difference between BeEAM and BEAM (p = 0.296; 0.762, respectively). Finally, our economic analysis revealed a net savings of $21,200 CAD per transplant when BeEAM is used in replacement of BEAM. The acceptable safety profile of BeEAM and its comparable efficacy to BEAM are encouraging for the perseverance of this cost-effective HDCT regimen.
Highlights
In many stem cell transplant centres, BCNU, etoposide, cytarabine and melphalan (BEAM) highdose chemotherapy (HDCT) has been replaced by the more economic and available bendamustine, etoposide, cytarabine, melphalan (BeEAM) regimen
There is a paucity of research comparing HDCT regimens in the context of stem cell transplantation
It is the first study to explore both the clinical and financial considerations associated with this widespread HDCT transition
Summary
In many stem cell transplant centres, BCNU, etoposide, cytarabine and melphalan (BEAM) highdose chemotherapy (HDCT) has been replaced by the more economic and available bendamustine, etoposide, cytarabine, melphalan (BeEAM) regimen. We compare overall and progression-free survival to a cohort of patients previously transplanted at our institution with the older BEAM regimen. The acceptable safety profile of BeEAM and its comparable efficacy to BEAM are encouraging for the perseverance of this cost-effective HDCT regimen. There is a paucity of research comparing BEAM and BeEAM conditioning regimens in terms of safety, efficacy and cost-effectiveness. A large cohort study conducted by Frankiewicz et al found no difference in grade 2–4 nephrotoxicity incidence between BeEAM and BEAM with each group demonstrating only a small risk of renal impairment (1.6% and 0.6%, respectively)[18]
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