Feasibility of and Decreased Inpatient Hospital Days for Non-Hodgkin Lymphoma (NHL) and Hodgkin Lymphoma (HL) Patients with Outpatient BEAM Using Daily Etoposide and Cytarabine and Autologous Hematopoietic Stem Cell Transplantation (AHCT)

Abstract

<h3>Introduction</h3> BEAM is a commonly used AHCT regimen for NHL and HL. The twice daily dosing of etoposide and cytarabine requires inpatient hospitalization, and pts remain inpatient until neutrophil recovery. We aimed to evaluate the feasibility and safety of outpatient BEAM with AHCT using daily etoposide and cytarabine. <h3>Methods</h3> We performed a retrospective analysis of patients treated with BEAM and AHCT in the outpatient transplant setting at Memorial Sloan Kettering Cancer Center from October 2018 to August 2019. Carmustine was given on day -6 (300mg/m2), etoposide (200mg/m2/dose) and cytarabine (400mg/m2/dose) daily from day -5 through day -2, and melphalan on day -1 (140mg/m2). Stem cell infusion and supportive care were performed per standard of care and institutional guidelines, including a delayed emesis prophylactic regimen of from D+1 to +7 after the first three pts. Packed red blood cells were given for hemoglobin <7g/dl and platelets for platelet counts <20K/mcl. <h3>Results</h3> For 18 pts, the median age was 38 (range 24-21) with 72% male. Lymphoma subtypes are shown in Figure 1. Median dose of CD 34+ cells infused was 6 × 10^6 CD34+cells/kg (range: 2.54-10.66). Cell infusions were given over 2 days in 3 pts. Washed cell infusions were administered to 6 pts. Median melphalan AUC was 6.2 (range 3.5-14, Figure 3). Median days to neutrophil engraftment was 9 (range: 8-12). Median number of platelet transfusions per pt was 4 (range: 2-8). Median packed red blood cells per pt was 1 (range: 0-6). Median number of days of grade2+ diarrhea was 3 (range: 0-11). Four pts (22%) required additional antiemetics outside the standard of care. Median weight lost per pt was 2.8kg (range: 0-10.3kg). Median number of intravenous fluid boluses was 5.5 (range: 1-10). Pts maintained a mean serum creatinine of 0.9mg/dl (range:0.7-1.5mg/dl). Engraftment syndrome was diagnosed in 44%. All patients were alive as of 9/30/19 with median follow-up of 62 days (range: 34-291). A total of 236 hospital days were saved using the outpatient regimen. Median number of hospital days saved per pt was 13. Fifteen pts required admission during the transplant course while 3 completed the transplant entirely outpt. Median day of hospital admission was +6 (range: +1 to +11). Reasons for admission are shown in Figure 2. Median number of inpt hospital days was 4 (range: 3-14). Ten pts returned to the outpatient stem cell transplant clinic for management prior to day 30. One pt was re-hospitalized prior to day 30. <h3>Conclusion</h3> BEAM using daily dosed etoposide and cytarabine with AHCT was not only feasible and safe for the outpatient setting, but also has the potential to reduce inpatient hospital days.