BEAM or ICE?

INTRODUCTION:High dose chemotherapy and autologous hematopoietic stem cell transplantation (AHSCT) has been widely used in the treatment of relapsed/refractory patients. As there are a few  randomized  studies comparing the conditioning regimens in AHSCT , we aim to analyze the transplant  outcomes of the patients who has been treated with BEAM or ICE  regimens.

PATIENTS-METHOD:We included sixty eight Hodgkin/Non Hodgkin lymphoma patients, who had been transplanted in our Bone Marrow Transplantation Unit between 2010-2012.Demographic features of the patients are summarized in Table 1. Only mantle cell and T cell lymphoma patients were transplanted in first CR otherwise all patients were transplanted in relapsed/refractory setting. Patients were  grouped according to conditioning regimens.We aimed to analyze the difference between the groups due to  the total number of febrile neutropenic days and hospitalization .We also  planned to compare the engraftment kinetics and side effects between the groups.

	BEAM(n:42)	ICE(n:26)
Diagnosis Hodgkin/Non Hodgkin lymphoma(n)	17/25	12/14	p:0.364
Median age (range)	43(17-66)	42(20-66)	P:0.622
Gender:F/M	26/16	18/8	p: 0.417
Pretransplantation status CR/PR/Refractory(n)	29/5/8	19/2/5	P:0.623
Pretransplantation RT(n)	9	5	P:0.542

Table 1.Patient demographics

RESULTS:The groups were comparable according to diagnosis,age,gender ,pretransplantation status of disease and pretransplantation radiotherapy. We also showed no difference between the groups according to infused CD344 cells, the number of febrile neutropenic days,hospitalization and neutrophile,platelet engraftment kinetics(Table 2). Nausea/vomitting was slightly higher in the BEAM group but the rates of mucositis were similar between the groups.

	BEAM	ICE
Mean of transplanted CD34+ cells	6.4 ±3.3	5.7 ±2.8	P:0.364
Day Number of febrile neutropenia	3(1-12)	4(1-10)	P:0.613
Day number of hospitalization	26(9-50)	24(12-67)	P:0.846
No of neutrophile engraftment day	12(9-34)	11(8-21)	P:0.354
No of platelet engraftment day	12(9-25)	12(8-21)	p:0.500

Table 2.Transplant outcomes

CONCLUSION:BEAM is one of the earliest described and traditionally accepted conditioning regimens in AHSCT  of Hodgkin/Non Hodgkin lymphoma patients. Attempts of several groups to change the drugs in BEAM regimens showed no evidence of more antitumor effect. We showed comparable transplantation outcomes between ICE and BEAM regimens.

We conclude that ICE regimen can be preffered as a conditioning regimen instead of BEAM regimen in selected patient groups.