Blood Res.  2019 Jun;54(2):108-113. 10.5045/br.2019.54.2.108.

Safety and efficacy of bendamustine in the conditioning regimen for autologous stem cell transplantation in patients with relapsed/refractory lymphoma

• Shabbir-Moosajee M
• Jehangir S
• Sawani S
• Muhammed T
• Ali N
• Sheikh U
• Adil S

• KMID: 2451010
• DOI: http://doi.org/10.5045/br.2019.54.2.108

Abstract

BACKGROUND
Bendamustine is an attractive option for the management of both de novo and relapsed lymphomas. It is being increasingly used in the conditioning regimen for autologous stem cell transplantation (SCT) and can be an alternative to the traditionally-used carmustine. In this study, we aimed to determine the safety and efficacy of bendamustine in the conditioning regimen for autologous SCT in refractory/relapsed lymphomas.
METHODS
We designed a descriptive study to evaluate bendamustine in combination with etoposide, cytarabine, and melphalan (BeEAM) in the conditioning regimen for autologous SCT.
RESULTS
Fourteen patients (median age, 28 yr) with Hodgkin's lymphoma (HL) (N=8), non-Hodgkin's lymphomas (NHL) (N=5), or peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) (N=1) were included in the study. A median number of 5.95×10⁶ CD34+ cells/kg were transfused. Median times to absolute neutrophil count and platelet engraftment were 17 days and 24 days, respectively. The 100-day transplantation mortality rate was 28% (4 patients). Eight patients (57.14%) had GII-III acute kidney injury, four patients (28.5%) had GIII-IV hyperbilirubinemia, and twelve patients (85%) had GII-III diarrhea. After 3 months, 37% (5 patients) and 21.4% (3 patients) demonstrated complete response and partial response, respectively. The median follow-up was 5.5 months (15 days-19 mo). At the final follow-up, 7 patients (50%) were alive and in CR.
CONCLUSION
Our study showed that bendamustine is a potentially toxic agent in the conditioning regimen for autologous SCT, resulting in significant liver, kidney, and gastrointestinal toxicity. Further studies are required to assess its safety and efficacy at reduced doses.

Keyword

Bendamustine; Toxicity; Autologous stem cell transplant; Lymphoma

MeSH Terms

Acute Kidney Injury
Bendamustine Hydrochloride*
Blood Platelets
Carmustine
Cytarabine
Diarrhea
Etoposide
Follow-Up Studies
Hodgkin Disease
Humans
Hyperbilirubinemia
Kidney
Liver
Lymphoma*
Lymphoma, Non-Hodgkin
Lymphoma, T-Cell, Peripheral
Melphalan
Mortality
Neutrophils
Stem Cell Transplantation*
Stem Cells*
Bendamustine Hydrochloride
Carmustine
Cytarabine
Etoposide
Melphalan

Figure

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  Fig. 1 Overall survival.

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  Fig. 2 Disease free survival.

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