The objective of this study is comparing the characteristics and outcomes of patients with lymphoma who received the conditioning regimen protocol with Lomustine, Etoposide, and Cyclophosphamide (LEC) for autologous hematopoietic stem cell transplantation, with patients with lymphoma who underwent another conditioning regimen protocol (CBV).

In the first step, the maximum tolerated dose of lomustine was set at 400 mg/m2, using a 3:3 scale. The second step consisted of evaluating the protocol with the use of lomustine (400 mg/m2) and etoposide (1g/m2) on day -5, followed by cyclophosphamide (6g/m2 from days -4 to -2). The results were compared with the historical series of patients submitted to conditioning with carmustine, cyclophosphamide, and etoposide (CBV). Treatment-Related Mortality (TRM), Progression-Free Survival (PFS), and Overall Survival (OS) were calculated.

Of the 109 patients evaluated, 42 received LEC and 67 received CBV. Sixty-six (60%) patients had Hodgkin's lymphoma, with the following distribution between the two protocols: CBV: 64% (42); and LEC: 36% (24). A total of forty-three (40%) patients had non-Hodgkin lymphoma, with the following histological types: Mantle cell lymphoma 25.6% (11); Diffuse large B-cell 48.8% (21); Peripheral T-cell 11.6% (5); Burkitt 2.32% (1); Anaplastic 2.32% (1); with 4 having histology not found in the medical records. Among patients with non-Hodgkin lymphoma, 42% (18) were submitted to LEC and 58% (25) to CBV. At the time of ASCT, 10 patients had refractory disease, with no statistically significant difference between treatment groups, as well as for age. Only one patient in the LEC group died within the first 100 days of ASCT, showing a trend toward lower TRM. OS at 2-years for the two conditioning protocols was 85.31% for LEC and 55% for CBV, respectively (p = 0.001).

The Autologous Stem Cell Transplantation (ASCT) is considered the consolidation treatment of choice for patients with relapsed Hodgkin's or non-Hodgkin's lymphoma, and the first line of treatment for eligible patients with aggressive T-cell or mantle cell non-Hodgkin's lymphoma. In this study, the LEC protocol, the conditioning regimen studied, proved to be safe and in line with what is desired for the treatment of patients with lymphoma today. With the scarcity and sometimes discontinuation of some chemotherapy drugs in Brazil, the use of alternative regimens, such as the one in this study, which demonstrated efficacy and safety, is corroborated.

LEC proved to be a safe protocol, with OS at 24-months being higher in the LEC group than in the CBV conditioning groups. Despite the good results with LEC, unfortunately, there is a new shortage of both lomustine and carmustine in Brazil, which will require the use of new alternative protocols.

The author declares no conflict of interest.