Abstract 5246: Comparison of Outcomes of Two Preparative Regimens for Lymphoma Patients Who Are Receiving Autologous Hematopoietic Stem Cell Transplantations

Comparison of outcomes of two preparative regimens for lymphoma patients who are receiving autologous hematopoietic stem cell transplantations

Background: Current literature supports the use of hematopoietic stem cell transplants (hSCT) over salvage chemotherapy for patients with lymphoma who have recurrent disease or are at high risk of relapse. Few studies have been published directly comparing preparative regimens, thus most institutions select regimens based on associated toxicities. At our institution, Busulfan/Cyclophosphamide (Bu-Cy) was historically used as the preparative regimen for patients with lymphoma. A transition was made in 2009 to favor the theoretically less toxic Carmustine/Etoposide/Cyclophosphamide (CBV) regimen for older patients.

Objective: Compare the tolerability and efficacy of Bu-Cy and CBV as they pertain to autologous stem cell transplants in older patients.

Methods: We report a retrospective review of institutional data evaluating the safety and efficacy of Bu-Cy and CBV in patients with lymphoma receiving an autologous hSCT between January 2005 and January 2014. Patients were excluded if they were less than 60 years of age. The primary outcome was the incidence of grade 3 and 4 toxicities per the CTCAE v4.03. Secondary outcomes included progression-free and overall survival.

Results:  Seventy-five patients were available for analysis, 23 received Bu-Cy and 52 received CBV. Patients who received Bu-Cy experienced an average of 1.6 severe or life-threatening toxicities per patient compared with 1.7 for those who received CBV. There was no difference in progression-free (BuCy 86% vs CBV 95%) or overall survival (BuCy 96% vs CBV 94%) at 60 days; however, there was a trend toward increased progression-free survival (BuCy 31% vs CBV 68%)  at three years and this trend was supported by the increased time to relapse (BuCy 22.7 vs CBV 61.2 months).

                    

Time to mortality                                                                                   Time to relapse

Conclusions: This review demonstrates no difference in terms of tolerability or efficacy between Bu-Cy and CBV; however, there is a trend towards improved relapse free survival with CBV. Future studies are needed to compare other utilized preparative regimens.