Dexa-BEAM is not effective in patients with relapsed or resistant aggressive high-grade non-Hodgkin's lymphoma

The aim of the present study was to evaluate the feasibility and response o f the Dexa-BEAM regimen as a salvage therapy followed by high-dose chemothe rapy (HDCT) with peripheral blood stem cell transplantation (PBCST) in resp onding patients with high-grade relapsed or resistant aggressive non-Hodgki n's lymphoma (NHL). Sixteen pretreated patients (mean age 44, range 26-59) with relapsed (8) or resistant (8) NHL were treated with 1-4 cycles of Dexa -BEAM (dexamethasone, BCNU, etoposide, cytarabine, melphalan) in order to a ttain maximal response. Patients achieving complete response (CR) or partia l response (PR) received HDCT with PBSCT. The conditioning regimen used was BEAM. Three patients achieved CR and one patient PR, resulting in an overa ll response rate of 25%. Three of four responding patients underwent high-d ose chemotherapy and were successfully transplanted with autologous blood s tein cells. Progressive disease developed in one patient after transplantat ion. Myelosuppression (WHO III degrees-IV degrees), the major side effect, was o bserved in all courses of Dexa-BEAM. Myelosuppression-related infection WHO IV degrees occurred in four patients. The protocol was not well tolerated in this heavily pretreated group of patients with four severe myelosuppress ion-related infections WHO IV degrees and one treatment-related death. The overall response rate in this study is not comparable to other salvage regi mens published and led to the discontinuation of the trial. In conclusion D exa-BEAM was only effective in a minority of patients with refractory or re lapsed aggressive NHL and was not useful as a cytoreductive regimen prior t o HDCT.