Fotemustine plus etoposide, cytarabine and melphalan (FEAM) as a new conditioning regimen for lymphoma patients undergoing auto-SCT: a multicenter feasibility study

BEAM is a widely used conditioning regimen for relapsed/refractory lymphoma patients undergoing auto-SCT. We conducted a multicenter study with an alternative regimen (fotemustine plus etoposide, cytarabine and melphalan (FEAM)) in which BCNU was substituted by the chloroethylnitrosourea fotemustine (FTM). Eighty-four patients with relapsed/refractory Hodgkin's (n20) and non-Hodgkin's lymphoma (n64) were conditioned with a FEAM regimen (FTM 150 mg/m 2 on days -7, -6, etoposide 200 mg/m 2 and cytarabine 400 mg/m 2 on days -5, -4, -3, -2 and melphalan 140 mg/m 2 on day -1). Patients were evaluated for toxicity and engraftment parameters. Median times to neutrophil (500 × 10 9 /l) and plt (20 000 × 10 9 /l) engraftment were 11 and 13 days, respectively. Grade 3 mucositis occurred in 19 patients (23%), while G3 nausea/vomiting and G3 diarrhea were observed in 13 (15%) and 6 (7%) patients, respectively. No severe hepatic, renal or pulmonary toxicity was detected. Seven patients (7%) experienced G4 mucositis, while no other G4 toxicities or unexpected adverse events of any grade were recorded. Transplant-related mortality was 2.4%. We conclude that a FEAM regimen is feasible and safe. Although toxicity and engraftment times compared favorably with BEAM, longer follow-up is needed to evaluate fully its efficacy and long-term safety. © 2010 Macmillan Publishers Limited All rights reserved.