This page tells you about the chemotherapy drug combination BEAM and its possible side effects. There is information about
BEAM is the name of a combination of chemotherapy drugs that includes
- B – Carmustine (BiCNU) or Lomustine (CCNU)
- E – Etoposide
- A – Cytarabine (Ara-C, cytosine arabinoside)
- M – Melphalan
The links above take you to information about the individual side effects of each drug.
BEAM is a treatment for Hodgkin lymphoma and non Hodgkin lymphoma.
You have BEAM chemotherapy as part of a stem cell transplant.
A nurse or doctor gives the drugs into your bloodstream (intravenously). You have them through a central line, a portacath or a PICC line. These are long, plastic tubes that go directly into a large vein in your chest. The tube can stay in place throughout the course of treatment.
You have BEAM in the following way
- On the first day of treatment you have carmustine as a drip, usually over 2 hours
- On the second day and the next 3 days you have cytarabine as a drip twice a day over 30 minutes. And you have etoposide as a drip once a day over 2 hours. Some hospitals give the cytarabine as a single dose
- On the 6th day you have melphalan as a drip over 15 to 30 minutes and another drip to give you extra fluids
- At least 24 hours after the melphalan you have your stem cells
You may hear your doctors name the days slightly differently. So that the first day of treatment is called minus 7 and they count down to the day you have the stem cells on Day 0. You usually stay in hospital during the 7 days of treatment and for 2 to 3 weeks afterwards.
During the treatment you can move around the ward even when the drip is going through. You have extra fluids (hydration) alongside the chemotherapy to help to keep your kidneys working properly.
There is a chemotherapy combination called mini-BEAM, which uses the same drugs at lower doses. Another combination is Dexa-BEAM, which is mini-BEAM with the steroid dexamethasone. You have both of these combinations as cycles of treatment. How many cycles you have depends on how well it works. The treatment is repeated every 4 to 6 weeks.
You may have the drug lomustine instead of carmustine. This combination is called mini-LEAM. Lomustine comes as blue capsules. You should keep them in a tightly closed container and out of the reach of children. You take the capsules on an empty stomach at bedtime. They should be swallowed whole with plenty of water. Your doctor will tell you the dose and when to take them. It is very important that you take the capsules according to the instructions your doctor or pharmacist gives you. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.
The side effects associated with BEAM are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Let your doctor or nurse know straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels. You will need to have antibiotics, anti fungal drugs and anti viral drugs, and may also have injections of GCSF to increase the number of white blood cells
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Diarrhoea affects 8 out of 10 people (80%) – drink plenty of fluids if you can and tell your doctor or nurse so that they can give you drugs to help control it
- Stomach pain
- Bruising more easily due to a drop in platelets – you may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia). You may need to have platelets in a drip. It usually takes about 3 to 4 weeks for the number of platelets to get to a safe level again
- A sore mouth – some people will also have mouth ulcers. 3 out of 4 people (75%) have very sore mouths and need to have painkillers. You will have mouthwashes to help to keep your mouth clean. You may also need to have a drip to feed you (total parenteral nutrition or TPN)
- Feeling or being sick happens in many people but you will have anti sickness medicines regularly – if they aren’t working tell your doctor or nurse
- Tiredness and weakness (fatigue) affects most people during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Hair loss – most people have complete hair loss but the hair grows back once the treatment ends
- Taste changes
- Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (plantar-palmer syndrome). This may cause tingling, numbness, pain and dryness
- Loss of appetite
- Lung problems – a cough or breathlessness can happen in up to 1 in 3 people (30%) due to inflammation of the lungs. Tell your doctor if you have this effect
- Women may stop having periods (amenorrhoea) but this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these.
- High uric acid levels in your blood due to cancer cells being broken down by the body – you will have regular blood tests. You will need to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol
- Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your kidneys are working
- Some people have an allergic reaction while having treatment, usually at the first or second treatment. Let your treatment team know straight away if you have any skin rashes, itching, or if you feel hot or shivery. Also tell them if you go red in the face, feel dizzy, or have a headache, shortness of breath, anxiety or a sudden need to pass urine
Fewer than 1 in 100 people have these effects.
- Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your liver is working
- There is a small risk that you may get a second cancer some years after treatment
You may have a few of the side effects mentioned on this page. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
These drugs may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drugs may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This information does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about these drugs look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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