Impact of Implementing a Bendamustine-Based Conditioning Regimen on Outcomes of Autologous Stem Cell Transplantation in Lymphoma while Novel Cellular Therapies Emerge

• Published in: Transplantation and cellular therapy 2023-01, Vol.29 (1), p.34.e1-34.e7
• Main Authors: Lachance, Sylvie, Bourguignon, Alex, Boisjoly, Josie-Anne, Bouchard, Philippe, Ahmad, Imran, Bambace, Nadia, Bernard, Léa, Cohen, Sandra, Delisle, Jean-Sébastien, Fleury, Isabelle, Kiss, Thomas, Mollica, Luigina, Roy, Denis-Claude, Sauvageau, Guy, Veilleux, Olivier, Zehr, Justine, Chagnon, Miguel, Roy, Jean
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autologous stem cell transplant; Bendamustine Hydrochloride - therapeutic use; Carmustine - adverse effects; Carmustine - therapeutic use; Chemosensitive; Conditioning optimization; Cytarabine - therapeutic use; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Lymphoma; Lymphoma - drug therapy; Melphalan - therapeutic use; Retrospective Studies; Transplantation, Autologous
• ISSN: 2666-6367; 2666-6367
• DOI: 10.1016/j.jtct.2022.10.003

•As novel therapies emerge, autologous stem cell transplantation allows for prolonged disease-free survival in patients with chemosensitive lymphoma.•High-dose chemotherapy preceding stem cell infusion is the active component of this cellular therapy.•Incorporating bendamustine in the conditioning regimen is feasible, safe, and effective.•Bendamustine-based conditioning is a valid alternative to BCNU to optimize transplantation outcomes in lymphoma. With the advent of new cellular and targeted therapies, treatment options for relapsed and refractory (r/R) lymphomas have multiplied, and the optimal approach offering the best outcomes remains a matter of passionate debate. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is still considered a treatment option for patients with chemosensitive lymphoma when cure is the expected goal. The myeloablative conditioning regimen preceding the stem cell infusion is considered the effective component of this approach. Carmustine (BCNU)-based preparative regimens, such as BEAM and BEAC, are considered the standard of care and have shown efficacy and low nonrelapse mortality (NRM). Comparative studies between conditioning regimens have failed to identify a better option. After a BCNU drug shortage in Canada followed by a steep increase in price, we elected to substitute BCNU for bendamustine (benda) in the preparative regimen. The purpose of this substitution was to improve response while preserving safety and controlling costs. From May 2015 to May 2018, a total of 131 consecutive lymphoma patients received benda-EAM conditioning. These patients were compared with 96 consecutive patients who received BCNU-based conditioning from January 2012 to May 2015. Apart from conditioning, supportive care measures were the same in the 2 groups. Patients receiving benda were older (55.7 years versus 51.1 years; P = .002). The development of grade ≥3 mucositis was more frequent with benda conditioning (39.5% versus 7.8%; P < .001) leading to a greater requirement for parenteral nutrition (48.9% versus 21.9%; P < .001). A transient creatinine increase >1.5 times the upper limit of normal (15.3% versus 4.2%; P < .008) and intensive care unit admission (6.9% versus 1.1%; P < .029) were more frequent with benda; however, there were no between-group differences in cardiac, pulmonary, or liver toxicity and NRM. With a median follow-up of 48 months for the benda group and 60 months for the BCNU group, benda wa