Adding rituximab (R) to conditioning with BCNU, etoposide, cytarabine, and melphalan (BEAM) for patients with diffuse large B-cell lymphoma (DLBCL) undergoing autologous hematopoietic cell transplantation (auto-HCT) did not yield significant differences in outcomes compared with BEAM alone, according to research published in Cancer.
Researchers analyzed data gathered from the Center for International Blood and Marrow Transplant Research Center (CIBMTR) registry on 862 patients with DLBCL who were 18 years of age or older and underwent auto-HCT between 2003 and 2017. Patients underwent conditioning with either BEAM (667 patients) or R-BEAM (195 patients). In addition, all patients received frontline chemoimmunotherapy with rituximab and had chemosensitive disease prior to transplant.
The primary end point was overall survival (OS). Secondary outcomes included nonrelapse mortality (NRM), relapse or progression, and progression-free survival (PFS).
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OS at 4 years was 61% in patients who received BEAM and 58% in patients who received R-BEAM (P =.77). The 1-year cumulative incidence of NRM was 5% in the BEAM cohort and 6% in the R-BEAM cohort (P =.44). At 4 years, the cumulative incidence of relapse or progression was 44% in the BEAM cohort and 41% in the R-BEAM cohort (P =.40).
On multivariate analysis, conditioning with R-BEAM was not associated with significant differences in OS (hazard ratio [HR], 1.03; 95% CI, 0.81-1.31; P =.83), PFS (HR, 0.94; 95% CI, 0.76-1.18; P =.61), NRM (HR, 1.43; 95% CI, 0.91-2.26; P =.12), or risk for relapse or progression (HR, 0.83; 95% CI, 0.65-1.07; P =.15) compared with conditioning with BEAM alone.
Age of 65 years or older was found to be associated with increased NRM risk (HR, 6.72; 95% CI, 1.63-27.78; P =.01). Variables identified as leading to poorer OS included age of 65 years or older (HR, 3.05; 95% CI, 1.81-5.13; P <.0001), absence of complete remission (HR, 1.67; 95% CI, 1.39-2.07; P <.0001), and early chemoimmunotherapy failure (HR, 1.52; 95% CI, 1.22-0.91; P =.001).
The leading cause of death in both cohorts was relapse, which occurred in 68% of patients receiving BEAM compared with 55% of patients receiving R-BEAM.
Overall, there were no significant differences in outcomes between the 2 cohorts. “Based on our results, routine use of [R-]BEAM conditioning prior to auto-HCT for DLBCL is not recommended,” the researchers concluded.
Reference
1. Jagadeesh D, Majhail NS, He Y, et al. Outcomes of rituximab‐BEAM versus BEAM conditioning regimen in patients with diffuse large B cell lymphoma undergoing autologous transplantation [published online February 12, 2020]. Cancer. doi:10.1002/cncr.32752
