Outpatient administration of BEAM conditioning prior to autologous stem cell transplantation for lymphoma is safe, feasible, and cost-effective

Abstract

High-dose BEAM chemotherapy (BCNU, etoposide, Ara-C, and melphalan) followed by autologous hematopoietic stem cell transplantation is frequently used as consolidative therapy for patients with recurrent or refractory Hodgkin or non-Hodgkin lymphoma. The BEAM regimen has traditionally been administered over 6 days in the hospital, with patients remaining hospitalized until hematologic recovery and clinical stability. In an effort to reduce the length of hospitalization for these patients, our institution has transitioned from inpatient (IP) to outpatient (OP) administration of BEAM conditioning. Here, we report the results of an analysis of the feasibility, cost, complications, and outcomes for the initial group of patients who received OP BEAM compared to a prior cohort of patients who received IP BEAM. Patient and disease characteristics were comparable for the two cohorts, as were engraftment kinetics. Length of hospital stay was reduced by 6 days for the OP cohort (P < 0.001), resulting in a cost savings of more than $17,000 per patient. Fewer complications occurred in the OP cohort, including severe enteritis (P = 0.01), organ toxicities (P = 0.01), and infections (P = 0.04). Overall survival rate up to 3 years posttransplant was better for the OP cohort (P = 0.02), likely due to differences in posttransplant therapies. We conclude that OP administration of BEAM conditioning is safe and may offer significant advantages, including decreased length of hospitalization, reduced costs, decreased risks for severe toxicities and infectious complications, and likely improvement in patient satisfaction and quality of life.

Keywords: Complications; conditioning chemotherapy; cost; stem cell transplantation.

Figure 1

Inpatient and outpatient BEAM‐conditioning regimens. BCNU: carmustine; ETP: etoposide; Ara‐C: cytarabine. Chemotherapy drugs were dosed on 25% corrected ideal body weight: CIBW = IBW + [(0.25) × (Actual BW – IBW)], where IBW in kg = 50 (male) or 45.5 (female) + (2.3 × height in inches over 60 inches).

Figure 2

Kaplan–Meir plots demonstrating overall survival (A) and progression‐free survival (B) for inpatient and outpatient BEAM cohorts.

Figure 3

Kaplan–Meir plots demonstrating overall survival and progression‐free survival for Hodgkin lymphoma (A) and non‐Hodgkin lymphoma (B) subsets of the inpatient and outpatient BEAM cohorts.