AI Article Synopsis
- The MEAM regimen, used before auto-PBSCT for malignant lymphoma, was adjusted to include a higher dose of Ara-C to improve drug delivery to the central nervous system.
- A retrospective analysis of 37 cases showed that all patients experienced engraftment with no treatment-related deaths, achieving a 3-year overall survival rate of 80.6% and a progression-free survival rate of 65.7%.
- While the high-dose Ara-C MEAM therapy proved safe and effective, its impact on central nervous system lesions could not be thoroughly assessed due to the limited number of cases.
Article Abstract
Aim: The MEAM regimen consisting of ranimustine (MCNU), etoposide (ETP), cytarabine (Ara-C), and melphalan (MEL) is widely used before auto-peripheral blood stem cell transplantation (auto-PBSCT) for malignant lymphoma in Japan. The MEAM regimen generally consists of 200-400 mg/m for 4 days, but we decided to increase the dosage of Ara-C from the standard to 2 g/m for 2 days with the aim of increasing drug transferability to the central nervous system. We evaluate the safety and therapeutic efficacy of high-dose Ara-C MEAM therapy.
Methods: The high-dose Ara-C MEAM protocol consisted of MCNU 300 mg/m on day -7, ETP 200 mg/m on days -6, -5, -4, -3 and Ara-C 2 g/m on day -4 -3, and MEL 140 mg/m on day -2. We retrospectively analyzed 37 cases of malignant lymphoma at our institution between May 2014 and July 2020.
Results: All patients got engraftment and there were no cases of treatment-related mortality. In all cases, the 3-year overall survival (OS) and progression-free survival (PFS) after transplantation were 80.6% and 65.7%, respectively. Twenty-one cases of diffuse large B-cell lymphoma recurrence, for which there is proven usefulness of auto-PBSCT, showed good results after transplantation, with the 3-year OS and PFS after transplantation being 100% and 74.3%, respectively.
Conclusion: The safety and efficacy of high-dose Ara-C MEAM therapy were demonstrated, but the expected therapeutic effect on central nervous system lesions could not be fully evaluated owing to the small number of cases.
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