Retrospective Analysis Leam Conditioning for Autologous Stem Cell Transplantation

Autologous stem cell transplantation (ASCT) is a standard treatment strategy for consolidation of chemo sensitive, relapsed aggressive or indolent B-cell and Hodgkin lymphomas for transplant-eligible patients. In Kothari et al's retrospective study; both LEAM (Lomustine, etoposide, cytarabine and melphalan) and BEAM (BCNU, etoposide, cytarabine and melphalan) were associated with significant gastrointestinal toxicity. The LEAM regimen was associated with worse gastrointestinal toxicity compared with BEAM, there was no difference in rates of sepsis, engraftment or other transplant-related parameters between the two cohorts. More patients conditioned with LEAM went to intensive care in the acute setting, but the difference was not significant and importantly, the non-relapse mortality was not statistically different between the two regimens. BEAM containing regimen is mostly used at many centers in our country. During the period BCNU was unavailable we substituted BEAM with LEAM that was developed in France. We retrospectively analyzed the early transplant data of 7 patients who were conditioned with LEAM (Lomustin 200 mg/m2, etoposide 800 mg/m2 (in divided doses), cytarabine 1600 mg/m2 (in divided doses) and melphalan140mg/m2). The characteristics of the patients are 6 male, 1 female, mean age 58 (43-69) years. Diagnosis were; 3 large B cell lymphoma with chemo sensitive relapse, 3 manthle cell lymphoma in first remission and 1 lymphocyte predominant lymphoma with chemo sensitive relapse. Median neutrophil and thrombocyte engrafment was 11.1 days (10-13) and 13, 75 days (10-19). All patients tolerated lomustine well with no additional antiemetic treatment. All patients had grade 3-4 mucositis and diarrhea, but none of them was in need of total parenteral nutrition. And all patients had febrile attacks, one patient had septic shock and one died of pseudomonas sepsis. We did not have any grade 3-4 renal and hepatic toxicity. Median hospital days were 21days (15-27), not longer than patients conditioned with BEAM or TEAM in our center. In this small number of patients, we did not see any unexpected side affects due to use of lomustine. Since, there is no universally accepted gold-standard conditioning regimen for ASCT, LEAM conditioning which is not preferred often can be a comparable regimen in countries where lomustine is available and noticeably cheaper, which we can not ignore.