USE OF BENDAMUSTIN INSTEAD OF CARMUSTIN IN AUTOLOGOUS STEM CELL TRANSPLANTATION CONDITIONING – TOXICITY AND INFECTIOUS COMPLICATIONS COMPARISON
Autori:
Ivan Zekanović, Nadira Duraković, Martina Morić Perić, Sandra Bašić-Kinda, Dubravka Sertić, Ranka Serventi Seiwerth, Silva Zupančić-Šalek,, Pavle Rončević, Ivo Radman, Marijo Vodanović, Alen Ostojić, Goran Rinčić, Ines Bojanić, Vlatka Periša, Dominik Lozić, Vedrana Gačić, Ivana Budisavljević, Igor Aurer
Sažetak
Unatrag nekoliko godina u hematologiji i onkologiji globalno sve češći problem postaje prikladna opskrba „starijim i manje zanimljivim“ kemoterapeuticima. Zbog povremene nestašice karmustina, jednog od osnovnih kemoterapeutika pri kondicioniranju prije autologne transplantacije krvotvornih matičnih stanica (ATKS) u oboljelih od limfoma, u našem se centru od 2016. godine on zamjenjuje bendamustinom. U ovom radu retrospektivno analiziramo tijek ATKS-a u 41 bolesnika koji su primili bendamustin u sklopu protokola BeEAM te ga uspoređujemo s tijekom ATKS-a u 40 bolesnika koji su primili karmustin u sklopu protokola BEAM. Medijan oporavka vrijednosti neutrofila (> 0,5 × 109/l) u skupini koja je primila bendamustin iznosio je 11 dana, dok je u skupini kondicioniranoj karmustinom iznosio 10 dana. Medijan oporavka vrijednosti trombocita (> 20 × 109/l) bio je duži kod skupine koja je primala bendamustin (16 prema 13 dana) te su ti bolesnici bili duže ovisni o transfuzijama eritrocita (7 prema 5 dana). Infektivne komplikacije nisu bile češće nakon primjene bendamustina, ali smo nakon primjene karmustina imali veću pojavu mukozitisa II. – III. stupnja (35% prema 12%). Nakon primjene bendamustina zabilježen je jedan slučaj nefrotoksičnosti i kardiotoksičnosti terapije, dok kod primjene karmustina te komplikacije nisu zabilježene. Pri upotrebi bendamustina kod kondicioniranja u naših bolesnika u ovom trenutku nije utvrđena znatnija hematološka toksičnost u odnosu prema karmustinu, ali su prisutni dulji period oporavka vrijednosti trombocita te niža incidencija mukozitisa.
Summary
Inadequate supply of „old and less interesting“ chemotherapeutic agents is becoming a global issue in hemato-oncology today. In 2016 we were faced with occasional carmustin shortage, one of the most commonly used in autologous transplant conditioning regimens for lymphoma in our centre, so we decided to use bendamustin instead. We performed a retrospective analysis of 41 patients treated at our centre who had received bendamustin within BeEAM protocol and compared them with 40 patients who had received carmustin within BEAM protocol. Both protocols were used as conditioning protocols before autologous stem cell transplantation. Neutrophil recovery median following transplantation (ANC>0,5×109/l) was 11 days in the bendamustin group in comparison to 10 days in the carmustin group.Platelets recovery median following transplantation (PLT>20×109/l) was longer in the bendamustin group (16 vs.13 days) as was blood transfusion dependency (7 vs. 5 days). Infectious complications were not more frequent after bendamustin, but grade II–III mucositis was more frequent in patients who received carmustin (35% vs.12%). Following bendamustin we had one reported case of nephrotoxicity and cardiac toxicity, not reported with carmustin. Bendamustin has shown similar hematologic toxicity compared to carmustin but a longer platelet recovery period and a lower mucositis incidence.
Alen Ostojić, Dominik Lozić, Dubravka Sertić, Goran Rinčić, Igor Aurer, Ines Bojanić, Ivan Zekanović, Ivana Budisavljević, Ivo Radman, Marijo Vodanović, Martina Morić Perić, Nadira Duraković, Pavle Rončević, Ranka Serventi-Seiwerth, Sandra Bašić-Kinda, Silva Zupančić-Šalek, Vedrana Gačić, Vlatka Periša
