Oral Busulfan and Cyclophosphamide (BU/CY) versus Cyclophosphamide, Melphalan and Vepsid (Etoposide) (CMV) with Autologous Stem Cell Transplant in Patients with Relapsed Non-Hodgkin Lymphomas (NHL)

Background: High dose chemotherapy with autologous stem cell transplantation (ASCT) is the standard of care and commonly used procedure for patients with relapsed non Hodgkin lymphomas (NHL). There is no clear evidence of superior conditioning regimen and studies that comparing different high dose regimens regarding the efficacy and toxicity profiles were little.

Objectives: To compare efficacy and toxicity profiles of BU/CY and CMV conditioning regimens in patients with relapsed NHL scheduled for ASCT.

Patients and Methods: Between June 2013 and January 2017, a total of 50 patients were enrolled in the study, 25 patients received CMV and 25 patients received BU/CY followed by ASCT in Bone Marrow Transplantation Center, Nasser Institute and El Sheikh zayed Hospitals, Egypt.

Results: The median time for both neutrophil and platelet engraftment showed no significant difference between the two groups (p= .4) and (p=.3) respectively. Transplant related mortality (TRM) was less in CMV arm, but p value didn't reach the statistical difference (p= .1). The 3- year DFS and OS were slightly higher in CMV arm. However, they didn't show any significant statistical difference 72.8% and 66.5%, (p =.81) and (p= .07). The toxicities, Grade III / IV mucositis, nausea/vomiting and diarrhea occurred slightly higher in BU/CY than in the CMV (16%, 24%, 8% vs. 12%, 16%, 4% respectively).Pulmonary toxicity was higher in BU/CY (3 patients (12%) in BU/CY arm and 1 patient (4%) in CMV arm). However, the toxicities didn't reach the statistical difference.

Conclusion: We found that both BU/CY and CMV regimens are not significantly different in terms of efficacy and toxicity. Although, the small number of patients that were enrolled in our study, we recommend further trial with larger number of patients to confirm the results.