Abstract C82: Carboplatin replacing BCNU in the BCNU, etoposide, cyclophosphamide (CVP) regimen for autologous stem cell transplant in patients with advanced lymphoma. Very low toxicity and encouraging results
Authors: Velez Miguel Gonzalez , Karduss-Urueta Amado Jose , Perez Rosendo , Gomez Luis Rodolfo , Jimenez Juan Alejo , Reyes Pedro Alejandro , Cardona Ana , Hurtado Liliana , Deossa Hilda , Fernandez Clara 
Published: May 2016

Introduction: Autologous stem cell transplantation (ASCT) is the standard of care for treating patients with advanced lymphomas. The most commonly employed preparative regimens are BCNU (Carmustine), etoposide, cytosine arabinoside, melphalan (BEAM), and BCNU, etoposide, cyclophosphamide (CVP). Both regimens use BCNU, but this medication is associated with pulmonary toxicity, besides, in some underdeveloped countries there is a serious shortage of it. Carboplatin is an agent with good activity in Hodgkin and non-Hodgkin´s lymphomas and has a tolerable toxicity profile. Here we present our experience in a bone marrow transplant service in Colombia (South America) a country with shortage of BCNU. We evaluated the effects of a high-dose chemotherapy regimen with carboplatin replacing BCNU in the CVP regimen.

Methods: After peripheral blood progenitor cells were mobilized with filgrastim 10 µg/kg for five days, twenty four patients with advanced lymphomas were conditioned prior to ASCT. The conditioning regimen consisted of carboplatin (450 mg/m2/ days -5,-4), etoposide (330 mgs mg/m2/days -4,-3,-2) and cyclophosphamide (2.000 mg/m2/days -3,-2,-1). After the autograft all patients received filgrastim or pegfilgrastim from day +5.

Results: 24 consecutive patients were transplanted, median age 39.2 years (range 5-70), eleven were female. 11 patients (46%) had Hodgkin lymphoma; 7 in CR2 and four in partial remission or with refractory disease. 13 (54%) had non-Hodgkin´s lymphoma classified as: 6 diffuse large B cell, 5 mantle cell, 2 transformed follicular. Patients with mantle cell lymphoma were in CR1 while the rest were in CR2. The median CD 34+ cells infused was 4.09 x 106 cells/kg. The median time to achieve 500/µL absolute granulocyte count and 20.000/µL platelets was 11.7 days (range 8-17), and 16.5 days (range 7-23) respectively. 20 out of 24 had febrile neutropenia, the other toxicities were mild; grade II mucositis in three patients, neutropenic colitis in two and hemorrhagic cystitis in one. There were no pulmonary or renal toxicities and the transplant related mortality was 0%. The four patients with active disease achieved complete remission after transplant but two of them have relapsed. The one year overall survival is 100%, with a median follow-up of 12 months (range 5-18), and the disease-free survival, estimated by Kaplan-Meier is 90%.

Conclusions: The use of carboplatin replacing BCNU in the CVP regimen seems to be a safe and effective conditioning protocol followed by ASCT in patients with various types of lymphomas. This treatment option seems an adequate alternative for underdeveloped countries with shortage of BCNU. The regimen shows good anti-tumor activity, with a tolerable toxicity profile. These promising results must be confirmed with the inclusion of more patients and a longer follow-up.

Citation Format: Miguel Gonzalez Velez, Amado Jose Karduss-Urueta, Rosendo Perez, Luis Rodolfo Gomez, Juan Alejo Jimenez, Pedro Alejandro Reyes, Ana Cardona, Liliana Hurtado, Hilda Deossa, Clara Fernandez. Carboplatin replacing BCNU in the BCNU, etoposide, cyclophosphamide (CVP) regimen for autologous stem cell transplant in patients with advanced lymphoma. Very low toxicity and encouraging results. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C82.