JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
for a standard adult patient and was communicated by Min Tran, PharmD. The cost of BCE may decrease if generic busulfan becomes available. As described in the recent review by experts, alternatives to BEAM conditioning are urgently needed because of the toxicity and limited supply of carmustin (BCNU). 3,20 In the age of sophisticated imaging 15 , targeted treatments 16,17 and immunotherapy 18 , BCE (or other efficacious and tolerable protocols) can serve as a platform to extend survival in patients with lymphomas who relapse after a first line treatment. Which protocol should a practicing transplant hematologist now in 2018 use for patients with NHL or HL who need an autoSCT? Ideally, a randomized controlled study could resolve the issue giving a balance between toxicity and anti-tumor effects. There are multiple reason why a randomized trial is not likely to be performed. There are many new drugs (for example BTK inhibitors and PI3kinase inhibitors) which will be used for relapsed or refractory lymphomas and can interfere with conditioning regimens. There are many clinical and molecular types of lymphomas which need an individualized treatment. Not all drugs are available in all countries. The practicing hematologist should choose based on personal experience, institutional preference, cost and availability.
non-Hodgkin’s lymphoma patients: A single enter comparative analysis of efficacy and toxicity. Leuk Res 2011; 35: 183- 187 11. Zhang H, Graiser M, Hutcherson DA, Dada MO, McMillan S, Ali Z, et al. Pharmacokinetic-directed high-dose busulfan combined with cyclophosphamide and etoposide results in predictable drug levels and durable long-term survival in lymphoma patients undergoing autologous stem cell transplantation. 2012; Biol Blood Marrow Transplant ; 18: 1287- 1294 12. Ahn JS, Yang DH, Jung SH, Chae YS, Sohn SK, Yhim HY, et al. Autologous stem cell transplantation with busulfan, cyclophosphamide, and etoposide as an intensifying frontline treatment in patients with peripheral T cell lymphomas: a multicenter retrospective trial. Ann Hematol 2013; 92: 789- 797 13. Vaughan WP, Dennison JD, Reed EC, Klassen L, McGuire TR, Sanger WG, et al. Improved results of allogeneic bone marrow transplantation for advanced hematologic malignancy using busulfan, cyclophosphamide and etoposide as cytoreductive and immunosuppressive therapy. Bone Marrow Transplantation 1991; 8: 489- 495 14. Berber I, Erkurt MA, Nizam I, Koroglu M, Kaya E, Kuku I et al. Can BuCyE conditioning regimen be an alternative treatment to BEAM at autologous transplantation in malignant lymphoma patients?: a single center experience. Int J Clin Exp Med. 2015 Sep 15;8(9):16308-14. 15. Evens AM and Kostakoglu L. The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease Blood 2014; 124:3356- 3364 . 16. Alperovich A and Younes A. Targeting CD30 using brentuximab vedotin in the treatment of Hodgkin lymphoma. The Cancer Journal 2016; 22 : 23- 26 17. Stiff PWhat is the role of autologous transplant for lymphoma in the current era? Education Program American Society of Hematology 2015; 74- 81 18. Ansell SM. Targeting immune checkpoints in lymphoma. Curr Opin Hematol 2015; 22: 337- 342 19. Flowers CR, Costa LJ, Pasquini MC, Le-Rademacher J, Lill M, Shore TB, et al. Efficacy of pharmacokinetics-directed busulfan, cyclophosphamide, and etoposide conditioning and autologous stem cell transplantation for lymphoma: Comparison of a multicenter phase II study and CIBMTR outcomes. Biol Blood Marrow Transplant 2016; 22: 1197- 1205 20. Isidori A, Christofides A, and Visani G. Novel regimens prior to autologous stem cell transplantation for the management of adults with relapsed/ refractory non-Hodgkin lymphoma and Hodgkin lymphoma: alternatives to BEAM conditioning. Leukemia & Lymphoma 2016; 2499- 2509 Thomas Atkinson, MD, Zaid Al-Qurayshi, MD, Yordanka Koleva, MPH, Rein- hold Munker, MD, Nakhle S. Saba, MD, Roy S. Weiner, MD, and Hana Safah, MD , are affiliated with Tulane University Medical Center, Section of Hematology / Oncology, New Orleans, LA. AlanM. Miller, MD, PhD, was affiliated with Baylor University Medical Center, Dallas, TX.
REFERENCES
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Dr. Safah can be reached at hsafah@tulane.edu.
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