P1367: COMPARISON CONDITIONING REGIMENS (BEEAC,LEAM,CLV) BEFORE AUTOLOGOUS STEM CELL TRANSPLANTATION FOR TREATMENT OF PRIMARY-REFRACTORY AND RELAPSED FORMS HODGKIN’S LYMPHOMA

Abstract

Background: High-dose chemotherapy (HDCT) followed by autologous transplantation of hematopoietic stem cells (ASCT) is the gold standard of treatment for patients with primary-refractory and relapsed forms of Hodgkin’s lymphoma (R/R HL).There are several most commonly used conditioning regimens for HDCT followed ASCT.However, there are currently no data on the conduct of randomized studies that would compare the effectiveness and toxicity of different regimens. Aims: Comparison HDCT (CLV, LEAM, BeEAC) as a conditioning regimen before ASCT for the treatment of R/R HL. Methods: In retrospective study were included 279 patients with HL, median age 30 years;121 men and 158 women. All patients received HDCT and ASCT in NMSC named after N.I.Pirogov (2006 - 2018). Conditioning regimens: CLV (cyclophosphamide, lomustine, etoposide) – 78 patients, LEAM (lomustin, etoposide, cytarabine, melphalan) – 129 patients, BeEAC (bendamustine, cytarabine, etoposide, cyclophosphamide) – 72 patients. Results: Hematologic toxicity of different regimens (CLV, LEAM, BeEAC). All patients developed grade IV neutropenia, anemia with/without transfusion necessity, severe thrombocytopenia with transfusion requirements in most cases. Duration of neutropenia was the same – 9 days. Duration of thrombocytopenia in CLV regimen – 9 days, LEAM and BeEAC -11 days. Anemia Grade II (median) was identified in CLV, Grade III (median) in LEAM and BeEAC regimens. Non-hematologic toxicity. Presented in Table 1. Table 1. - Toxicity of different regimens. Transplant-related mortality (until D + 30) was: CLV -1,3 %, LEAM- 3,1 %, BeEAC – 2,8%. Efficiency of condition regimens. Comparison of OS and PFS of different regimens pretended in figure 1,2. Characteristic CLV LEAM BeEAC Oral mucositis 34,6% (n=27) 56,6% (n=72) 40,3 % (n=29) Enteropathy 16,2 % (n=13) 60,4% (n=78) 39% (n=28) Cardiotoxic effects 1,38 % (n=1) 2,3% (n=3) 6,9% (n=5) Pulmonary toxicity 1,3% (n=1) 0% (n=0) 4,1% (n=3) Hepatic toxicity 15,4% (n=12) 17,0% (n=22) 27,8 % (n=18) Infection 68% (n=53) 76% (n=98) 69,4%(n=50) Image:Summary/Conclusion: HDCT followed ASCT is the best therapeutic approach for a R/R HL. HDCT is of utmost importance, with BeEAC, LEAM and CLV conditioning regimens being considered as viable alternatives. Our results suggest a comparable efficacy of BeEAC, LEAM and CLV conditioning in terms of survival and disease control for HL patients treated with HDCT and ASCT. However, we also observed higher rates of gastrointestinal and cardiac toxicities in patients transplanted after LEAM and BeEAC. The worst OS in patients received LEAM can be explained by the fact that the regimen was used in our hospital earlier than others, when such drugs as Nivolumab and Brentuximab vedotin were not available to the patients with relapse after HDCT and ASCT.