Comparison Of The Tolerability Of Busulfan, Cyclophosphamide, Etoposide (Bucyvp) Versus Carmustine, Etoposide, Cytarabine, Melphalan (Beam) For Autologous Hematopoietic Cell Transplant (Ahct) In Hodgkin Lymphoma

Background BuCyVP and BEAM are two commonly used conditioning regimens for AHCT. Previous literature has reported improved outcomes with BEAM compared to BuCyVP in Hodgkin lymphoma (HL) patients, although results in non-Hodgkin lymphoma (NHL) patients are scarce but similar. Our institution switched from using BuCyVP to BEAM as AHCT conditioning for HL in 2016. We conducted a retrospective study to evaluate tolerability and resource utilization with the two regimens. Given limited data and comparable outcomes, this may influence decisions to use one regimen over the other in patients with NHL. Objectives Assess resource utilization and toxicity of BEAM vs. BuCyVP in patients undergoing AHCT for HL. The primary endpoint was hospital length of stay (LOS). Secondary outcomes were 30-day readmission rates, incidence of fever, time to neutrophil and platelet engraftment, incidence of transfer to intensive care unit (ICU), time on intravenous (IV) opioids, and incidence of diuretic and breakthrough antiemetic use. Methods Beginning March 2016, BEAM replaced BuCyVP as the standard conditioning regimen for AHCT for HL at our institution. We retrospectively reviewed medical records of HL patients receiving BuCyVP with pharmacokinetic (PK)-guided therapeutic dose monitoring (TDM) of busulfan from October 2014 through March 2016 (N = 19) and BEAM from April 2016 through September 2017 (N = 18). Results BuCyVP recipients had significantly longer average hospital LOS, relative to both admission date (21 vs. 19 days, p  Conclusions Compared to BuCyVP, patients receiving BEAM as conditioning for AHCT for HL had significantly shorter hospital LOS, fewer episodes of fevers and required less IV opioids and furosemide. However, there was no difference in other endpoints evaluated (e.g., neutrophil engraftment, ICU transfer and breakthrough antiemetic use). Our study provides the background information on expected resource utilization and toxicities for the two regimens and will assist in decisions regarding use of these regimens in NHL patients where outcomes between the two are comparable