DA Koroleva, EE Zvonkov
National Research Center for Hematology, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167
For correspondence: Daria Aleksandrovna Koroleva, 4 Novyi Zykovskii pr-d, Moscow, Russian Federation, 125167; Tel.: +7(495)612-44-72; e-mail: email@example.com
For citation: Koroleva DA, Zvonkov EE. Carmustine in the Therapy of B-Cell Lymphomas. 2021;14(4):496–502. (In Russ).
Aim. To analyze the efficacy and toxicity of different high-dose chemotherapy protocols for the purpose of determining the optimal conditioning regimen with autologous hematopoietic stem cell transplantation (auto-HSCT).
Materials & Methods. The present review provides the analysis of some comparative retrospective studies. The evidence-based analysis proceeded in two stages consisting of a search and then primary processing of available literature. The PubMed database was searched for publications for the period 2004–2020.
Results. In relapsed and refractory non-Hodgkin’s lymphomas as well as in Hodgkin’s lymphoma, the literature analysis demonstrated satisfactory efficacy of carmustine as part of BEAM conditioning. With the use of the BEAM conditioning regimen with subsequent auto-HSCT, up to 50 % of complete remissions were achieved in patients with non-Hodgkin’s lymphomas and up to 70 % in patients with Hodgkin’s lymphoma. Comparative studies show that despite concerns about severe toxicity, the use of carmustine was not associated with an increase in the incidence of adverse events. Lung and liver toxicity proved to be comparable with that of being observed while using alternative programs of high-dose chemotherapy and corresponded to 9 % and 6 % on LEAM and BEAM regimens, respectively. Besides, carmustine feasibility in primary diffuse large B-cell CNS lymphoma was considered and analyzed in the context of the lack of thiotepa.
Conclusion. High efficacy of carmustine as part of BEAM conditioning with subsequent auto-HSCT was proved in extremely unfavorable patients with relapsed and refractory non-Hodgkin’s lymphomas and Hodgkin’s lymphoma with an acceptable toxicity profile. The study of carmustine in the therapy of primary CNS lymphoma seems to be аn important area of clinical studies aimed at developing rational treatment options.
Keywords: carmustine, non-Hodgkin’s lymphomas, Hodgkin’s lymphoma, auto-HSCT, lomustine, thiotepa, primary diffuse large B-cell CNS lymphoma.
Received: July 15, 2021
Accepted: September 10, 2021Статистика Plumx английский
- Fleming AB, Saltzman WM. Pharmacokinetics of the carmustine implant. Clin Pharmacokinet. 2002;41(6):403–19. doi: 10.2165/00003088-200241060-00002.
- Damaj G, Cornillon J, Bouabdallah K, et al. Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: A review. Bone Marrow Transplant. 2017;52(7):941–9. doi: 10.1038/bmt.2016.340.
- Fenske TS, Zhang MJ, Carreras J, et al. Autologous or reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chemotherapy-sensitive mantle-cell lymphoma: Analysis of transplantation timing and modality. J Clin Oncol. 2014;32(4):273–81. doi: 10.1200/jco.2013.49.2454.
- Dreyling M, Lenz G, Hoster E, et al. Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network. Blood. 2005;105(7):2677–84. doi: 10.1182/blood-2004-10-3883.
- Wang TF, Fiala MA, Cashen AF, et al. A phase II study of V-BEAM as conditioning regimen before second auto-SCT for multiple myeloma. Bone Marrow Transplant. 2014;49(11):1366–70. doi: 10.1038/bmt.2014.163.
- Bachanova V, Burns LJ. Hematopoietic cell transplantation for Waldenstrom macroglobulinemia. Bone Marrow Transplant. 2012;47(3):330–6. doi: 10.1038/bmt.2011.105.
- Sharma A, Kayal S, Iqbal S, et al. Comparison of BEAM vs. LEAM regimen in autologous transplant for lymphoma at AIIMS. Springerplus. 2013;2(1):1–6. doi: 10.1186/2193-1801-2-489.
- Colita A, Colita A, Bumbea H, et al. LEAM vs. BEAM vs. CLV Conditioning Regimen for Autologous Stem Cell Transplantation in Malignant Lymphomas. Retrospective Comparison of Toxicity and Efficacy on 222 Patients in the First 100 Days After Transplant, On Behalf of the Romanian Society for Bon. Front Oncol. 2019;9:892. doi: 10.3389/fonc.2019.00892.
- Kothari J, Foley M, Peggs KS, et al. A retrospective comparison of toxicity and initial efficacy of two autologous stem cell transplant conditioning regimens for relapsed lymphoma: LEAM and BEAM. Bone Marrow Transplant. 2016;51(10):1397–9. doi: 10.1038/bmt.2016.134.
- Tsang ES, Villa D, Loscocco F, et al. High-dose Benda-EAM versus BEAM in patients with relapsed/refractory classical Hodgkin lymphoma undergoing autologous stem cell transplantation. Bone Marrow Transplant. 2019;54(3):481–4. doi: 10.1038/s41409-018-0328-9.
- Joffe E, Rosenberg D, Rozovski U, et al. Replacing carmustine by thiotepa and cyclophosphamide for autologous stem cell transplantation in Hodgkin’s and non-Hodgkin’s B-cell lymphoma. Bone Marrow Transplant. 2018;53(1):29–33. doi: 10.1038/bmt.2017.205.
- Duque-Afonso J, Ihorst G, Waterhouse M, et al. Comparison of reduced-toxicity conditioning protocols using fludarabine, melphalan combined with thiotepa or carmustine in allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2021;56(1):110–20. doi: 10.1038/s41409-020-0986-2.
- Puig N, De La Rubia J, Remigia MJ, et al. Morbidity and transplant-related mortality of CBV and BEAM preparative regimens for patients with lymphoid malignancies undergoing autologous stem-cell transplantation. Leuk Lymphoma. 2006;47(8):1488–94. doi: 10.1080/10428190500527769.
- Caimi PF, William BM, Rondon CH S, et al. Comparison of 2 Carmustine-Containing Regimens in the Rituximab Era: Excellent Outcomes Even in Poor-Risk Patients. Biol Blood Marrow Transplant. 2015;21(11):1926–31. doi: 10.1016/j.bbmt.2015.06.007.
- Kirschey S, Flohr T, Wolf HH, et al. Rituximab combined with DexaBEAM followed by high dose therapy as salvage therapy in patients with relapsed or refractory B-cell lymphoma: Mature results of a phase II multicentre study. Br J Haematol. 2015;168(6):824–34. doi: 10.1111/bjh.13234.
- Brandes AA, Tosoni A, Amista P, et al. How effective is BCNU in recurrent glioblastoma in the modern era? A phase II trial. Neurology. 2004;63(7):1281–4. doi: 10.1212/01.wnl.0000140495.33615.ca.
- Alnahhas I, Jawish M, Alsawas M, et al. Autologous Stem-Cell Transplantation for Primary Central Nervous System Lymphoma: Systematic Review and Meta-analysis. Clin Lymphoma Myel Leuk. 2019;19(3):е129–е141. doi: 10.1016/j.clml.2018.11.018.
- Omuro A, Correa DD, DeAngelis LM, et al. R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS lymphoma. 2015;125(9):1403–10. doi: 10.1182/blood-2014-10-604561.