Autologous Bone Marrow Transplantation - Blog Science Connections

BEAM: Cytoreductiue Regimen for Lymphomas 597
Mucositis: mild in 80% of patients
Table 4. Toxicity of BEAM Regimen
Aplasia: No. of days
WBC < 1000/mm3; median, 17.7 (range, 7-31)
Neutrophils < 500/mm 3 : median, 19.7 (range, 10-33)
Neutrophils < 200/mm 3 : median, 13.7 (range, 4-24)
Platelets < 50,000/mm3; median, 26.5 (5 patients: > 45 days)
Prolonged fever: 15
Interstitial pneumonitis: 7 (3 fatal)
Miscellaneous toxicities:
1 cystitis, 1 bowel obstruction, 1 hepatic injury, 1 sudden death,
2 renal failures (1 fatal)
1 lung edema (1 fatal)
General toxicity of BEAM:
morbidity 28 patients 54%
mortality 6 patients 11.5%
5 in progression or in relapse 18.1%
1 in CR 5.8%
Abbreviations: BEAM, BCNU (carmustine), etoposide, aracytine (cytarabine),
melphalan; CR, complete response.
During aplasia, when prolonged fevers were observed in 15 patients,
seven of these fevers were not characterized, four were in relation to a
gram-positive sepsis (3 Staphylococcus epidermidis and 1 Streptococcus
D) and two in relation to a gram-negative sepsis (1 Pseudomonas aeruginosa
and 1 Proteus morgani). One fungal infection with Torulopsis glabrata and
one documented herpes infection were also recorded.
Seven patients experienced an interstitial pneumonitis. Two were not
characterized, two were related to a proved cytomegalovirus infection, one to
a proved Candida albicans, one to aspergillosis, and one to Mycoplasma
pneumoniae. Three of the seven (1 cytomegalovirus-related, 1 aspergillosisrelated,
and 1 undocumented infection) were fatal.
Miscellaneous toxic effects were observed in seven patients. The two
patients who had renal failure had received a cisplatin-containing regimen as
second-line chemotherapy 4 weeks before the BEAM. In the patient who died
of renal failure, the vancomycin level was very high after only 2 days of
treatment and probably contributed to the fatal outcome. The fatal, acute
lung edema observed in another patient was probably of infectious origin.
The sudden death, on day 38 without preceding or accompanying
symptoms, of a 44-year-old patient as he was watching TV at home must also
be recorded. We have no explanation for this death in remission (the family
refused necropsy).
In summary, as the data in Table 4 show, morbidity was observed in 28 of
52 patients and toxic death in 6 patients. There was no difference in the