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CEAC (oral semustine, etoposide, cytarabine and cyclophosphamide) vs BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning regimen of autologous stem cell transplantation for diffuse large B-cell lymphoma: a post-hoc, propensity score-matched, cohort study in Chinese patients

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Abstract

Autologous stem cell transplantation (ASCT) is a salvage therapy for relapsed or refractory diffuse large B-cell lymphoma (DLBCL). We have developed a novel conditioning regimen called CEAC (oral semustine 250 mg/m2 d-6, etoposide 300 mg/m2 d-5 ~ d-2, cytarabine 500 mg/m2 d-5 ~ d-2, and cyclophosphamide 1200 mg/m2 d-5 ~ d-2) In lymphoma patients in China. Here, we conducted a study to compare the conventional BEAM regimen with the CEAC regimen in 110 DLBCL patients. Propensity-score matching was performed in a 1:4 ratio (22 patients received BEAM and 88 received CEAC). Our results showed no significant difference in the overall response rate (95% vs 97%, P = 1.000) and complete response rate (66% vs 73%, P = 0.580) between the two cohorts. The 5-year progression-free survival (PFS), 5-year overall survival (OS), and 5-year cumulative incidence of relapse (CIR) for all patients were 72% (95% CI 62%–82%), 92% (95% CI 86%–97%), and 29% (95% CI 17%–38%), respectively. There was no significant difference in the 5-year PFS (80% vs 70%, P = 0.637), 5-year OS (95% vs 91%, P = 0.496), and 5-year CIR (20% vs 30%, P = 0.733) between cohorts. In terms of safety, the CEAC cohort had a lower incidence rate of grade 1–2 gastrointestinal hemorrhage (P = 0.023) and severe nausea (P = 0.007) compared with the BEAM cohort. In conclusion, the CEAC regimen seems to be a suitable alternative to the BEAM regimen for ASCT in DLBCL patients.

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Data are available from the authors upon reasonable request.

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Acknowledgements

The authors thank the patients who have participated in the study. This work was supported by Science and Technology Commission of Shanghai Municipality (23YF1458800) and grants from the National Natural Science Foundation of China (NSFC) (82270202). We would like to thank MogoEdit (https://www.mogoedit.com) for its English editing during the preparation of this manuscript.

Funding

Tao Wang received funding from the Science and Technology Commission of Shanghai Municipality (23YF1458800), and Jianmin Yang received funding from the National Natural Science Foundation of China (NSFC) (82270202).

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  1. Tao Wang and Ping Liu contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Hematology, Institute of Hematology, Changhai Hospital, Naval Medical University, Shanghai, 200433, China

    Tao Wang, Ping Liu, Lili Xu, Lei Gao, Xiong Ni, Gusheng Tang, Li Chen, Jie Chen, Libing Wang, Yang Wang, Weijia Fu, Wenqin Yue, Na Liu, Ruobing Li, Guihua Lu, Yanrong Luo & Jianmin Yang

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  1. Tao Wang
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Contributions

JY, YL and GL designed the study approved the final version of the manuscript. TW and PL analyzed the data, wrote the manuscript. LX, LG, XN, GT, LC, JC, LW, YW, WF, WY, NL and RL collected the data and critically revised the manuscript.

Corresponding authors

Correspondence to Guihua Lu, Yanrong Luo or Jianmin Yang.

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Wang, T., Liu, P., Xu, L. et al. CEAC (oral semustine, etoposide, cytarabine and cyclophosphamide) vs BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning regimen of autologous stem cell transplantation for diffuse large B-cell lymphoma: a post-hoc, propensity score-matched, cohort study in Chinese patients. Ann Hematol 103, 575–582 (2024). https://doi.org/10.1007/s00277-023-05513-x

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