Bone Marrow Transplantation (2018) 53:1553–1559 https://doi.org/10.1038/s41409-018-0196-3 ARTICLE High-dose therapy with BEAC conditioning compared to BEAM conditioning prior to autologous stem cell transplantation for non- Hodgkin lymphoma: no differences in toxicity or outcome. A matched-control study of the EBMT-Lymphoma Working Party Stephen Paul Robinson 1 ● Ariane Boumendil 2 ● Herve Finel 2 ● Peter Dreger 3 ● Anna Sureda 4 ● Olivier Hermine 5 ● Silvia Montoto 6 Received: 30 October 2017 / Revised: 17 March 2018 / Accepted: 22 March 2018 / Published online: 8 June 2018 © Macmillan Publishers Limited, part of Springer Nature 2018 Abstract A recent shortage of melphalan has prompted the use of alternatives to BEAM (BCNU, Etoposide, Cytarabine, Melphalan) conditioning for autologous stem cell transplantion (ASCT). The BEAC (BCNU, Etoposide, Cytarabine, Cyclopho- sphamide) regimen has been employed as a conditioning regimen in lymphoma patients. However, there have been recent concerns about the toxicity of BEAC. We conducted a retrospective analysis of the EBMT database comparing the outcome of patients conditioned using BEAC with a matched cohort of patients conditioned with BEAM. In the BEAC cohort (n = 383), 25 patients died from non-relapse mortality (NRM) events (32% owing to MOF or cardiac toxicity). In the BEAM cohort (n = 766) there were 34 NRM events (23% owing to MOF or cardiac toxicity). The 1-year cumulative incidence of NRM was 4% in the BEAC cohort and 3% in the BEAM group (p = ns). The 2-year relapse/progression rate was 32% with BEAC and 33% with BEAM (p = ns). At 2 years the progression-free survival (PFS) and overall survival (OS) were 63% and 78% for BEAC and 63% and 77% for BEAM-conditioned patients (p = ns for PFS and OS). The toxicity observed with BEAC conditioning as measured by NRM was similar to that seen with BEAM. The outcomes following BEAC were similar to those seen with BEAM, suggesting that BEAC is a safe conditioning regimen. Introduction High-dose therapy and autologous stem cell transplantation (ASCT) is commonly employed in a variety of patients with relapsed lymphomas and to consolidate first line induction therapy in mantle cell and T-cell lymphomas [1, 2]. A number of different high-dose therapy regimens have previously been described and are now currently employed in routine clinical practice [3, 4]. To date, there has been no prospective study comparing these various regimens and consequently the relative efficacy and toxicities have not been established [4]. The selection of high-dose con- ditioning regimen has therefore been left to the discretion of individual institutions. Over the last two decades, BEAM (BCNU, Etoposide, Cytarabine, Melphalan) has become the most widely used conditioning regimen and now accounts for over 90% of the transplants reported to the EBMT registry [5]. Clinicians have therefore become familiar with this regimen and its anticipated toxicities. In recent years problems in the manufacture and supply of both BCNU and melphalan have compromised the ability of transplant centres to employ the BEAM regimen and consequently alternative high-dose conditioning regimens have been selected by different centres. The BEAC (BCNU, Etoposide, Cytarabine, Cyclophosphamide) regimen has previously been described as a conditioning regimen for * Stephen Paul Robinson stephen.robinson@ubht.nhs.uk 1 University Hospital Bristol NHS Foundation Trust, London, UK 2 The Lymphoma Working Party EBMT, Paris, France 3 University Hospital Heidelberg, Heidelberg, Germany 4 Institut Catala d’Oncologia, Hospital Duran I Reynals, Barcelona, Spain 5 Hopital Necker, Paris, France 6 St Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK 1234567890();,: 1234567890();,: