Background

Approximately half of patients with relapsed chemosensitive disease achieve robust responses with BEAM (BCNU, etoposide, cytarabine, and melphalan) and autologous stem cell rescue. The scarcity of comparative studies further limits alternative treatment protocols, such as the MITO/MEL (mitoxantrone, melphalan) protocol.

Patients and Methods

In this retrospective multicenter study, we compared the BEAM and MITO/MEL regimens used before autologous hematopoietic stem cell transplantation (ASCT) in terms of efficacy and side effects in patients with Hodgkin lymphoma. Data met international accreditation rules. Before ASCT, 108 patients received the MITO/MEL, and 34 patients received the BEAM.

Results

The median follow-up time was 36 months in the MITO/MEL group (range, 3-178) and 23 months in the BEAM group (range, 4-99). After ASCT, the 3-year expected overall survival and disease-free survival rates were 86.1% and 86.1% for the MITO/MEL group and 91.3% and 76.5% for the BEAM group, respectively. Although 50% of patients developed febrile neutropenia attacks in the MITO/MEL group, this rate was 91.1% in the BEAM group. The grade II and higher rates of hepatic, renal, gastrointestinal, and cardiac toxicities were similar in both groups. However, the rate of pulmonary toxicity was determined to be 1.9% in the MITO/MEL group and 29.4% in the BEAM group (P < .001).

Conclusion

The MITO/MEL conditioning regimen seems to be as effective as the BEAM regimen but has better tolerability in terms of pulmonary toxicity and may be used as an alternative option if necessary, depending on the comorbidity status of the patient.

中文翻译：

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用于霍奇金淋巴瘤自体造血干细胞移植的 BEAM 和 MITO/MEL 调理方案的比较：效率和治疗相关毒性的分析。

背景

大约一半的复发性化学敏感疾病患者通过 BEAM（BCNU、依托泊苷、阿糖胞苷和马法兰）和自体干细胞拯救获得了强烈的反应。比较研究的缺乏进一步限制了替代治疗方案，例如 MITO/MEL（米托蒽醌，美法仑）方案。

患者和方法

在这项回顾性多中心研究中，我们比较了自体造血干细胞移植 (ASCT) 之前使用的 BEAM 和 MITO/MEL 方案对霍奇金淋巴瘤患者的疗效和副作用。数据符合国际认证规则。在 ASCT 之前，108 名患者接受了 MITO/MEL，34 名患者接受了 BEAM。

结果

MITO/MEL 组的中位随访时间为 36 个月（范围，3-178），BEAM 组的中位随访时间为 23 个月（范围，4-99）。ASCT 后，MITO/MEL 组的 3 年预期总生存率和无病生存率分别为 86.1% 和 86.1%，BEAM 组分别为 91.3% 和 76.5%。尽管 MITO/MEL 组有 50% 的患者出现发热性中性粒细胞减少症，但 BEAM 组的这一比例为 91.1%。两组的肝、肾、胃肠道和心脏毒性的 II 级和更高发生率相似。然而，MITO/MEL 组的肺毒性发生率为 1.9%，BEAM 组为 29.4% ( P  < .001)。

结论

MITO/MEL 预处理方案似乎与 BEAM 方案一样有效，但在肺毒性方面具有更好的耐受性，必要时可用作替代方案，具体取决于患者的合并症状态。