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598 BEAM: Cytoreductiue Regimen for Lymphomas
morbidity rate of the patients treated during relapse (18 of 28, 64.2%) and
patients treated as first line (10 of 17, 59%). In contrast, a difference was
observed, although not a significant one, in the toxic death rate: 5 of 28
(18.1%) patients treated during relapse died of toxic effects, compared with
the deaths of 1 of 17 (5.8%) patients who received first-line treatment.
DISCUSSION
BEAM showed an effective response rate for Hodgkin's disease in this
preliminary study, with six responses in seven patients, and five complete
responses. These results, even if preliminary, indicated that this regimen
should be investigated in relation to relapse of Hodgkin's disease in a larger
group of patients.
In patients with non-Hodgkin's lymphoma, the overall response rate was
73%, with 65% of patients showing a complete response. A high response rate
among patients in sensitive relapse and first PR was related to a poor
response rate for patients in resistant relapse and disease progression (Table
5). Despite the small number of patients in this group, these results
suggested that the BEAM regimen is not indicated for progressive disease.
However, the BEAM regimen was devised for "good-risk" patients in an
attempt to reduce toxicity, a goal that was achieved. Indeed, tolerance and
toxicity with this regimen seemed better than those of other conditioning
regimens used in NHL (4). An important improvement with BEAM was that
the generally observed mucositis was very mild.
Miscellaneous complications remained of concern, however, and the
interstitial pneumonitis and lung edema observed were an indirect toxic effect
of carmustine and melphalan. The renal failures were cisplatin-related and
could be avoided if one removed cisplatin from the salvage chemotherapy
preceding high-dose melphalan.
The sudden death of a patient remains unexplained but may be related to
Table 5. Morbidity and Mortality of BEAM Regimen
Morbidity
Mortality
Patient Condition No. of Patients No. % No. %
Resistant relapse,
progressive disease 9 4 44.4 1 11.1
Sensitive relapse 19 14 73.6 4 21
Total 28 18 64 5 17.8
First partial response 5 3 60 0 0
First complete response 12 7 58 1 8.3
Total 17 10 59 1 5.8
Abbreviation: BEAM, BCNU (carmustine), etoposide, aracytine (cytarabine),
melphalan.