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BEAM: Cytoreductlue Regimen for Lymphomas 599
Table 6. Toxic Death Rate: Comparison of BACT and BEAM
No. of
Toxic Deaths
Authors Ref. Regimen Patients Number Percentage
Appelbaum et al. 1,6 BACT 22 4 18.2
Philip ef al. 9,10 BACT +/-TBI 17 4 23.5
Hartmann ef al. 2 BACT-IGR 16 3 18.7
This report BEAM 52 6 11.5
Abbreviations: BACT, carmustine, cytarabine, cyclophosphamide, thioguanine;
BEAM, BCNU (carmustine), etoposide, aracytine (cytarabine), melphalan; TBI, total
body irradiation; IGR, Institut Gustave-Roussy.
the case of a patient described by Hartmann et al. (2), a patient who also died
suddenly, 14 days after BACT without other symptoms or explanations.
A comparison of the toxic death rate observed with BACT with that of
BEAM (Table 6) emphasizes the fact that the toxic cost of the BEAM regimen
is low. Furthermore, this toxic cost is only 5.8% for patients treated in first PR
or CR.
In conclusion, we recommend the BEAM regimen because there is a
good response rate in NHL patients not in CR after induction chemotherapy
and in patients in relapse who are still sensitive to a rescue protocol. The
toxicity of this regimen is very low (in both mild mucositis and mortality);
however, more aggressive conditioning regimens should be explored for
patients in resistant relapses and for primary refractory patients even if high
morbidity and mortality rates are expected.
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