BEAM is a type of chemotherapy used to treat Hodgkin lymphoma and non-Hodgkin lymphoma.
BEAM is a high-dose chemotherapy treatment. It's given before a stem cell transplant. A stem cell transplant allows you to have much higher doses of chemotherapy. This can improve the chances of curing your cancer. Some people have BEAM chemotherapy in lower doses. This is known as mini-BEAM.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
Treatment with high-dose chemotherapy destroys cancer cells in your bone marrow. It also destroys special blood cells in the bone marrow called stem cells, which make all the blood cells your body needs. After you are given high-dose chemotherapy, you will be given stem cells as a drip into a vein. The stem cells will go into your bone marrow and begin to make new blood cells.
You can read more about this in our information about high-dose treatment with stem cell support.
The drugs used in BEAM
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BEAM is named after the initials of the chemotherapy drugs used, which are:
This treatment will be given to you in hospital. You will have BEAM a week before you have the stem cells. You will be in hospital for a few weeks after the stem cell transplant until your blood cells are getting back to their normal levels.
A chemotherapy nurse will give you your treatment. You will also see a cancer doctor, a blood specialist (haematologist), a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day you are given BEAM, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs as an injection into a vein or as tablets.
Your treatment will be given through one of the following:
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
The drugs will run through a pump, which gives you the treatment over a set time. You will also be given extra fluids through a drip before and after chemotherapy. This is to protect your kidneys.
Your course of BEAM
With BEAM, the first day of your treatment is sometimes called ‘day minus seven’. This is because you will have BEAM seven days before you have the stem cells. There will be a countdown to the day you are given the stem cells, which is called day zero.
Day minus seven: Your nurse will give you carmustine as a drip (infusion) over two hours.
Day minus six until day minus three: You will have cytarabine twice a day as a drip over 30 minutes. You will also have etoposide once a day as a drip over two hours.
Day minus two: Your nurse will give you melphalan as a drip over 30 minutes and a drip giving you lots of fluids.
Day minus one: You won’t be given any chemotherapy drugs but you'll have fluids as a drip.
Day zero: Your nurse will give you the stem cells as a drip into your central line.
When BEAM chemotherapy is being given
Some people might have side effects while they are having BEAM chemotherapy. These may include:
Rarely, BEAM may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash, feeling itchy, flushed or short of breath, swelling of your face or lips, feeling dizzy, having pain in your tummy, back or chest, or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having carmustine, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common, but if it happens, it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact your doctor or nurse straight away on the number they gave you.
Possible side effects of BEAM
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We explain the most common side effects of BEAM here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Because BEAM is high-dose chemotherapy, your doctors and nurses will check you regularly. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
BEAM reduces the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia. Your doctor will prescribe you antibiotics and anti viral drugs to help prevent infections. Your nurse may give you injections of a drug called GCSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
While you’re in hospital, the nurses will check you regularly for signs of infection. You will also have daily blood tests to check your number of blood cells (blood count).
When you are home, contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Bruising and bleeding
BEAM reduces the number of platelets in your blood. Platelets are cells that help the blood to clot. You may have bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
BEAM reduces the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days of your chemotherapy. The nurses will give you anti-sickness drugs regularly. If you still feel sick, tell your nurse or doctor. They can change the anti-sickness drug to one that works better for you.
Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Feeling extremely tired is a common side effect. You’ll feel tired for some months after your treatment finishes. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
When you have BEAM chemotherapy, you will usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
This treatment may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe steroid eye drops to help prevent this. It’s important to use these as instructed.
It may also make your eyes more sensitive to light and cause blurry vision. Always tell your doctor or nurse if you have pain or notice any change in your vision.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat. Your skin may darken. It will return to its normal colour after you finish treatment.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar, or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Changes in the way the kidneys work
The treatment can affect how your kidneys work. You will have blood tests before and during treatment to check this. Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing.
Tumour lysis syndrome (TLS)
BEAM may cause the cancer cells to break down very quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but may not be able cope with large amounts. This can cause chemical imbalances in the blood that affect the kidneys and the heart. This is called tumour lysis syndrome (TLS).
To reduce the risk of TLS, your doctor may give you a drug called rasburicase. You will have this as a drip. You will also be given fluid through your drip to help protect your kidneys. You may only need rasburicase with the first treatment. After that, you can have tablets called allopurinol (Zyloric ®) instead.
Changes in the way the liver works
BEAM can change the way your liver works. This will usually go back to normal after treatment finishes. The drug may cause your skin and the whites of your eyes to turn yellow (jaundice). You will have regular blood tests to check how well your liver is working.
Less common side effects of BEAM
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Reaction to cytarabine
Cytarabine may cause a reaction 6-12 hours after it has been given. Signs of a reaction can include: a high temperature or chills, a rash, and pain in the eyes, bones, tummy or chest. Tell your nurse straight away if you have any of these symptoms.
Effects on the lungs
BEAM can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Effects on the nervous system
BEAM can affect the nervous system. You may feel drowsy, confused, dizzy or unsteady. You may have pins and needles or feel tingling in your arms and legs. Tell your doctor or nurse straight away if you notice any of these symptoms.
It’s important to let your nurse or doctor know straight away if you feel unwell or have side effects, even if they’re not mentioned above.
Rarely, BEAM can increase the risk of developing a second cancer, usually leukaemia, years later. But the benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Other information about BEAM
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After treatment with BEAM, any blood and platelets you are given should first be treated with radiation. This lowers the risk of the donated blood cells reacting against your own. It won’t damage the blood or make you radioactive.
Your doctor will record in your medical notes that you should only be given irradiated blood products. They’ll also give you a card to carry in case you’re treated at another hospital. Keep this card with you at all times and remind your hospital team that you need irradiated blood or platelets.
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
BEAM will affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources, including:
Perry MC. The chemotherapy source book. 5th edition. 2012. Lippincott Williams and Wilkins.
electronic Medicines Compendium (eMC). medicines.org.uk (accessed November 2013).
With thanks to: Catherine Loughran, Lead Pharmacist Haematology who reviewed this edition.
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