BEAM versus EAM, FEAM, BeEAM, and TEAM: exploring conditioning strategies in autologous stem cell transplantation for Hodgkin lymphoma a retrospective study of the LWP of EBMT.

BEAM (carmustine, etoposide, cytarabine, and melphalan) remains the most used chemotherapy for autologous hematopoietic stem cell transplantation (HSCT) in chemosensitive relapsed Hodgkin's lymphoma (HL). Nevertheless, alternatives have been developed to overcome drugs availability, costs, or potential toxicities. These include BeEAM (substitute carmustine with bendamustine), FEAM (using fotemustine instead of carmustine), TEAM (incorporating thiotepa instead of carmustine) and EAM (without bendamustine, fotemustine, thiotepa or carmustine). We analysed 13207 adults with HL who underwent HSCT in EBMT centers from 2010 to 2022. Chemotherapy was BEAM in 77% (n = 10167), FEAM in 13% (n = 1702), BeEAM in 6% (n = 729), TEAM in 3% (n = 365), and EAM in 2% (n = 244). In multivariable analysis, BeEAM was associated with decreased overall survival (OS) (HR 1.61, p = 0.003) and progression free survival (PFS) (HR 1.48, p < 0.001), higher relapse incidence (RI) (HR 1.43, p < 0.001) and non-relapse mortality (NRM) (HR 1.85, p = 0.04). EAM regimen was also associated with decreased OS (HR 1.55, p = 0.019). Propensity score matching was performed as a sensitivity analysis and confirmed the results of the multivariable analysis. We observed poorer outcomes in patients who received bendamustine in our cohort.