Comparison of BEAM and TEAM Conditioning Regimens Before Autologous Hematopoietic Stem Cell Transplantation in the Treatment of Lymphomas
At the beginning of this year, one of the few studies comparing the most commonly used conditioning regimen before autologous hematopoietic stem cell transplantation (ASCT) in patients with lymphomas (BEAM) with a regimen containing thiotepa instead of carmustine (TEAM) was published.
BEAM and TEAM Conditioning Regimens
Conditioning regimens before ASCT are among the fundamental therapeutic procedures for patients with lymphomas. The most commonly used regimen is BEAM (carmustine, etoposide, cytarabine, and melphalan), but others are also used. One of them is TEAM (thiotepa, etoposide, cytarabine, and melphalan). Data on the efficacy and safety comparison of these regimens are nonetheless scarce. Therefore, the authors of the cited retrospective study focused on them.
Retrospective Data Analysis
The study was conducted in the form of data analysis from medical records of adult patients diagnosed with lymphoma who underwent either the BEAM or TEAM conditioning regimen followed by ASCT between 2016 and 2019 at the Johns Hopkins Anatolian Health Center in Istanbul or at the private Medstar Hospital in Antalya, Turkey. Only patients with complete demographic and clinical data and subsequent follow-up were included. The treatment choice was not based on age, gender, diagnosis, or comorbidity index.
Evaluated Patient Group
A total of 294 patients were analyzed. Their median age was 50 years, 60.5% were men, 35% had diffuse large B-cell lymphoma (DLBCL), other diagnoses included Hodgkin lymphoma, T-cell lymphoma, etc. The BEAM regimen was administered to 72.8% of the included patients, and the TEAM regimen to 27.2%. Demographic and clinical characteristics were similar in both groups. In the BEAM regimen group, there was a higher proportion of patients achieving first complete remission (CR1), while in the TEAM group, there was a higher proportion of patients achieving first partial remission (PR1). The median follow-up was comparable in both therapeutic groups and amounted to approximately 4.5 years.
Findings
- Regarding safety, patients in the TEAM group experienced a significantly longer time to platelet engraftment (p = 0.003) and more frequent nausea (p = 0.031); in the BEAM group, a higher incidence of fever of unknown origin was noted (p = 0.042).
- Complete remission was achieved in 70.3% of patients in the BEAM group and 57.5% in the TEAM group.
- Overall mortality was 35% in the BEAM group and 43% in the TEAM group, which represents a statistically insignificant difference (p = 0.22).
- Three-year survival was 67% in the BEAM group and 66% in the TEAM group, five-year survival was 58% and 52%, respectively; in both cases, the differences were statistically insignificant.
Conclusion
The authors concluded that with BEAM and TEAM conditioning regimens before ASCT in lymphoma patients, similar overall survival is achieved with a comparable safety profile. However, with the BEAM regimen, which contains carmustine instead of an alkylating agent, a higher proportion of complete remissions and longer progression-free survival can be expected.
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Source: Deveci B., Ateşoğlu E. B., Bayrak E. et al. Comparative efficacy and safety of beam and team conditioning regimens for autologous stem cell transplantation in lymphoma patients. Transplant Proc 2023 Jan-Feb; 55 (1): 235−241, doi: 10.1016/j.transproceed.2022.12.001.
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