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BEAM

BEAM is the name of a combination of chemotherapy drugs that includes: 

  • B – Carmustine (BCNU)
  • E – Etoposide
  • A – Cytarabine (Ara-C, cytosine arabinoside)
  • M – Melphalan

It is a treatment for Hodgkin lymphoma and non-Hodgkin lymphoma

You usually have BEAM chemotherapy a week before a stem cell transplant.

Variations of BEAM

There are different variations of BEAM and this means that some people have lower amounts (doses) of drugs or different cancer drugs. Here are some of the different variations:

LEAM

When lomustine is used instead of carmustine the combination is called LEAM. Lomustine comes as capsules. Your doctor will tell you how much (dose), when and how to take it. 

Mini-BEAM

Mini-BEAM uses the same drugs as BEAM but at lower doses. 

Dexa-BEAM

This is the same as mini-BEAM with the steroid dexamethasone added to it. 

How BEAM works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells as well as healthy cells from your bone marrow. 

How you have BEAM

You have BEAM as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

When you have BEAM

You have BEAM just before you have a stem cell transplant. Doctors call the first day of BEAM treatment minus 6. They then count down to the day you have the stem cells which is called day 0.

You usually go into hospital the day before you start BEAM on day minus 7.

This is what BEAM treatment looks like:

Day -7
  • You go into hospital.
Day -6
  • You have carmustine as a drip into your bloodstream over 2 hours.
Day -5
  • You have cytarabine as a drip into your bloodstream over 30 minutes twice a day.
  • You have etoposide as a drip into your bloodstream over 2 hours.
Day -4
  • You have cytarabine as a drip into your bloodstream over 30 minutes twice a day.
  • You have etoposide as a drip into your bloodstream over 2 hours.
Day -3
  • You have cytarabine as a drip into your bloodstream over 30 minutes twice a day.
  • You have etoposide as a drip into your bloodstream over 2 hours.
Day -2
  • You have cytarabine as a drip into your bloodstream over 30 minutes twice a day.
  • You have etoposide as a drip into your bloodstream over 2 hours.
Day -1
  • You have melphalan as a drip into your bloodstream over 15 to 30 minutes.
  • You also have a drip with fluids running before and after the melphalan.
Day 0
  • You have the stem cells through a drip into your bloodstream 12 to 24 hours after melphalan.
Day 1 onwards
  • You recover from the chemotherapy and stem cell transplant. You have other drugs during this time such as medicines to prevent you from feeling or being sick, infection, getting a sore mouth and getting a blood clot.
  • From day 5 you have G-CSF each day until your white blood cell count is above 1 for at least 24 hours. G-CSF isn’t chemotherapy. It makes the body produce white blood cells to reduce the risk of infection.

You usually stay in hospital for about 2 to 3 weeks after your stem cell transplant. 

Tests

You have blood tests before, during and after your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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 petechiae).

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Headaches and dizziness

Let your doctor or nurse know if you have headaches or feel dizzy. Your team can give you painkillers. 

Low blood pressure

Tell your doctor or nurse if you feel light headed or dizzy. You have your blood pressure checked regularly.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines, but it can be severe. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Diarrhoea and constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Lung problems

You might develop a cough or breathing problems. This could be due to inflammation of the lungs (pneumonitis) or scarring or thickening of the lung. Rarely you might develop an infection, such as pneumonia. Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Eye problems

These drugs can cause eye problems such as blurred vision, sore or red eyes.

Less commonly, cytarabine can cause bleeding, watery, burning or stinging eyes. Your eyes might also move quickly from side to side (nystagmus) or be sensitive to light.

Tell your doctor or nurse if you have this as they might be able to prescribe eye drops to soothe them.

Confusion, changes in speech, balance and coordination

You might feel confused and find it difficult to think straight. Your speech might become slurred. You might feel unbalanced and the way you walk might be affected. Let your doctor know if you have any of these. 

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after taking this drug.

Muscle pain and weakness

This drug can cause muscle pain or weakness in different parts of the body. Let your treatment team know so they can tell you what can help to reduce it.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Skin colour changes

This treatment may change the colour of your skin. This usually goes away after you stop the treatment. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • a second cancer such as acute leukaemia
  • changes to your brain causing memory loss, personality changes and confusion. This can happen with high dose carmustine and can be serious
  • reddening (flushing) of your skin
  • an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening. Contact your treatment team alert your nurse or doctor if you notice any of these symptoms
  • an irregular heart beat (arrhythmia)
  • a heart attack – you’ll be closely monitored when having this drug treatment
  • high blood pressure signs which might cause headaches, confusion, vision problems or chest pain
  • difficulty swallowing
  • high temperature (fever)
  • skin problems such as a rash, reddening, blistering and itching
  • back passage inflammation and ulcers - talk to your team about if you have this
  • drowsiness
  • inflammation of the blood vessels
  • kidney problems and difficulty passing urine – you have regular blood tests to check for this

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a serious reaction to an infection (sepsis) signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
  • growth of breast tissue in men
  • joint pain
  • inflammation of the sac around the heart – signs might include feeling hot and sweaty, shortness of breath and lightheaded
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Pregnancy and contraception

This treatment 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 at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations 

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
09 Apr 2020
Next review due: 
09 Apr 2023
  • Guideline on the management of primary resistant and relapsed classical Hodgkin lymphoma
    G P Collins and others
    British Journal of Haematology, 2014. Volume 164, Pages 39 – 52

  • Electronic Medicines Compendium 
    Accessed April 2020

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • LEAM vs. BEAM vs. CLV Conditioning Regimen for Autologous Stem Cell Transplantation in Malignant Lymphomas. Retrospective Comparison of Toxicity and Efficacy on 222 Patients in First 100 Days After Transplant, On Behalf of the Romanian Society for Bone Marrow Transplantation
    A Colitia and others
    Frontiers in Oncology, 2019. Volume 9, Pages 1 – 10.

  • The EBMT Handbook Hematopoietic Stem Cell Transplantation and Cellular Therapies
    E Carrera
    EBMT (eBook), 2019

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.