CBV regimens vary in the dose of carmustine administered. More recent analysis of CBV regimens have shown improved outcomes when compared to earlier analysisrr In a retrospective analysis of 4917 patients Chen et al compared BEAM, CBVHIGH(carmustine ~ 450 mg/m2), CBVLOW (carmustine ~300 mg/m2), BuCy and TBI conditioning regimens and found that outcome varied based on histology and the conditioning used. They found that in patients with HL 3 year PFS were comparable between BEAM (60%), CBVLOW (60%), CBVHIGH (57%) and 3 year OS in this group were 79%, 73% and 68% respectively. Disease progression at 3 years was between 30-32% for all regimens.r
In patients with DLBCL CBVLOW and BEAM had similar OS and PFS (55%, 47% and 58%,47%). In this group CBVHIGH had worse OS and PFS (43%, 39%). In patients with Follicular lymphoma CBVLOW demonstrated a greater 3year OS, PFS (81%, 67%) when compared to CBVHIGH (60%, 60%) and BEAM (73%, 52%). In patients with Mantle Cell Lymphoma 3 year OS was greatest in the CBVHIGH (80%) however this was associated with an increased rate of disease progression at 3 years when compared to BEAM (44% vs 27%).
Puig et al compared the morbidity and mortality of patients treated with BEAM and CBV (High dose carmustine 800 mg/m2).r Their data suggests much higher 150 day TRM for the CBV group (25%) compared to BEAM (7%). A larger more recent retrospective analysis by Chen et al reported the one year TRM is the same for HL and NHL with rates of 4% for BEAM, 7% for CBVLOW and 8% for CBVHIGH. Risk factors for TRM were identified as older age, male gender, Karnofsky performance status <90, higher number of previous chemotherapy regimens, earlier year of ASCT and a history of smoking.r
Salar et al found that time to engraftment varies with conditioning regimen.r With CBV and BEAM conditioning medium time to granulocyte recovery (>0.5 x 109/L) was 12 days and platelet recovery (>20x109/L) was 15 days. This was more rapid than for Cy-TBI conditioning with median granulocyte and platelet recovery times of 14 and 20 days respectively.
Figure 1: Adjusted probability of overall survival after autologous hematopoietic cell transplantation for (A) Hodgkin lymphoma, (B) follicular lymphoma, (C) diffuse large B cell lymphoma, and (D) mantle cell lymphoma according to conditioning regimen.r
© Biol Blood Marrow Transplant 2015