JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Comparison of Outcomes for the BCE Regimen in the Literature
Age Median (years)
Dosages
HL / NHL
Age Median (years)
Reference
Number of Pts.
H ä nel et al., 2002 9
53
B: 4 mg/kg x 4d C: 60 mg/kg x 2d E: 30-45 mg/kg x 1d B: 3.2 mg/kg x 2½ d C: 60 mg/kg x 2d E: 40 mg/kg x 1½ d B: 3.2 mg/kg x 3d C: 50 mg/kg x 2d E: 400 mg/m 2 2d B: 3.6 mg/kg x 4d C: 60 mg/kg x 2d E: 10 mg/kg x 3d B: 3.2 mg/kg x 3d C: 50 mg/kg x 2d E: 400 mg/m 2 x 2d B: 4.0 mg/kg x 4d C: 60 mg/kg x 2d E: 200 mg/m 2 x 2d B: targeted x 4d C: 2.5 g/m 2 x 2d E: 1.4 g/m 2 x 1d B: 3.2 mg/kg x 4d C: 60 mg/kg x 2d E: 40 mg/kg x 1d
18.9% / 81.1%
46
≈ 22 months
Dean et al., 2009 4
0% / 100%
58
> 4 years
136
Kim et al., 2011 10
0% / 100%
48.5
22.6 months
22
Zhang et al., 2012 11
199
40.0% / 60.0%
47
> 5 years
Ahn et al., 2013 12
31
0% / 100% 47
> 4 years
Berber et al., 2015 14
31
25.8% / 74.2% 40.9*
24.0 months
Flowers et al., 2016 19
207
32% / 68% 51
> 4-5 years
Current Study
51
47.1% / 52.9% 46
4.8 years
Abbreviations: B busulfan, C: cyclophosphamide, E: etoposide, *: mean
Table 3: Comparison of Outcomes for the BCE Regimen in the Literature
conditioning regimens in autologous transplantation. 3 These experts feel that BEAM and BCE are comparable but more studies investigating outcomes, toxicities and costs are needed. They also mention other, less commonly used regimens. Despite different patient characteristics (in one study BCE was used as first line consolidation for T cell lymphomas 12 ), the long- term outcome of our patients is comparable to the other case series (Table 3). The variation in outcomes in different protocols is related to the indications for transplant and the quality of supportive measures. Recently, the outcome of a multicenter study of 203 patients in North America (66 HL patients and 137 patients with different types of NHL, all treated between 2010 and 2012) was reported by Flowers et al. 19 The short term outcome (survival at two and three years) in that study
was slightly better compared with our study; the long-term outcome is not shown due to limited follow-up. The study by Flowers et al. includes matching in the CIBMTR database with patients treated with BEAM conditioning. While the outcome for NHL was comparable, the matching for HL indicated a worse outcome with BCE compared to BEAM. The patient population in the study by Flowers et al. is older than in our study and dosing of chemotherapy is different (busulfan with targeted levels, cyclophosphamide and etoposide according to body surface area). Originally, the BCE protocol was developed for allogeneic bone marrow transplantation. 13 With the use of peripheral stem cells and intravenous busulfan, the toxicities of BCE have become manageable. The cost of the drugs used in the BCE protocol in the United States (AWP) is currently higher than in BEAM (41,600 US $ versus 32,700 US $). The cost was calculated
38 J La State Med Soc VOL 170 MARCH/APRIL 2018
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