Treatment-Related Toxicity of the BEAM/BeEAM Conditioning Regimen in Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation.

Abstract

Conditioning regimens prior to hematopoietic stem cell transplantation (HSCT) are highly intensive and associated with significant toxicity, which can influence survival and quality of life. This study aimed to analyze the incidence of gastrointestinal, hematological toxicity, changes in quality of life, and cognitive functions in lymphoma patients undergoing autologous HSCT with BEAM/BeEAM conditioning. A total of 27 lymphoma patients indicated for autologous HSCT were enrolled in this prospective observational study from January 2020 to August 2023. Data collection was performed at admission and at the end of hospitalization, prior to discharge. Monitored parameters included laboratory tests (hematology and biochemistry), patient-reported quality of life assessed using the QLQ-C30 questionnaire, and perceived cognitive function evaluated using the FACT-Cog questionnaire. Mucositis of any grade occurred in 25 patients (92.6%), with diarrhea being the most common gastrointestinal symptom (any grade 85.2%, grade 3-4 37.0%). Diarrhea severity was generally independent of age, baseline blood counts, engraftment, weight loss, or hospitalization, except for an association between severe diarrhea and lower pre-transplant TSH (p=0.03). All patients experienced grade 1-2 weight loss, and 81.5% developed febrile neutropenia. Quality of life declined during transplantation, notably in role functioning, social functioning, and cognitive performance, alongside worsening fatigue, nausea/vomiting, pain, appetite loss, and diarrhea (all p-values <0.05). FACT-Cog scores showed no significant cognitive decline. The 2-year overall survival was 92.1% (95% CI 81.6-100%), while patients with SII >520.81 had lower survival (82.5%, 95% CI 60.4-100%, p=0.04), with higher SII significantly associated with worse outcomes. Autologous transplantation and the BEAM/BeEAM conditioning regimen are associated with considerable mucosal and hematologic toxicity. Patients are at risk of infections, nutritional deficits due to reduced intake, and deterioration in quality of life.