This information is about a high-dose chemotherapy treatment called BEAM. It's given before a stem cell transplant for Hodgkin lymphoma and non-Hodgkin lymphoma.
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Treatment with high-dose chemotherapy destroys cancer cells in your bone marrow. However, it also destroys your healthy stem cells, which are early blood cells found in the bone marrow. To help you make new blood cells, your own or a donor's stem cells are first collected. Once you have recovered from this process a few weeks later, you'll be given high-dose chemotherapy and then the stem cells will be given back to you. The stem cells find their way to the bone marrow where they start to make new blood cells.
We have more information about high-dose treatment with stem cell support and about donor (allogeneic) stem cell transplants.
The drugs that are used
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BEAM is named after the initials of the chemotherapy drugs used.
How treatment is given
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This treatment is given to you while you're in hospital; usually over a period of eight days. After this you'll be given your own or your donor's stem cells. You'll need to stay in hospital until your blood cells have recovered to a safe level and you're well enough to go home.
Before you start your treatment you will need to have a blood test. This may be taken the day before you're admitted to hospital. You'll be seen by a doctor and may also see a specialist nurse or pharmacist. If the results of your blood tests are normal, the pharmacy will prepare your chemotherapy drugs. It can take several hours before your chemotherapy is ready.
BEAM chemotherapy is given as a drip (infusion). This can be given in one of the following ways:
Through a thin, plastic tube inserted under the skin and into a vein near your collarbone (central line).
Through a fine tube inserted into the crook of your arm (PICC line).
Your doctor or nurse will explain more about this to you. Your drip will be run through an infusion pump that controls the flow of fluid into your vein.
You'll be given anti-sickness (anti-emetic) drugs as tablets or by injection through your central line.
Having the treatment
Hospitals vary in the exact timing of giving BEAM, but the treatment is usually given over a period of eight days. You'll only have chemotherapy on six of those days. Your doctor or specialist nurse will explain this to you in more detail.
The first day is usually called Day minus 7, which is a countdown to having the stem cell infusion on Day 0.
Day –7 You'll be given carmustine (a colourless fluid) as a drip (infusion) over two hours.
Day –6 until Day –3 On these four days you will have cytarabine (a colourless fluid) given twice a day as an infusion over 30 minutes. You'll also have etoposide (a colourless fluid), which is given once a day as an infusion over two hours.
Day –2 Melphalan (a colourless fluid) is given once as an infusion over 30 minutes. You'll also have lots of fluids (as an infusion) to help flush out the chemotherapy drugs.
Day –1 You won't be given any chemotherapy drugs. You'll probably still be having an infusion of fluid.
Day 0 You'll be given the stem cells, which are given as an infusion into your central line.
Before and after treatment with BEAM you'll be given lots of fluids by drip (infusion) to keep your kidneys working normally.
Some people have BEAM chemotherapy in lower doses. This is known as mini-BEAM. It's sometimes given to help the doctors decide if BEAM and a transplant is the right treatment for you.
Each person’s reaction to high-dose chemotherapy is different. Not all of the side effects described here will affect everyone who is given BEAM.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you.
Because this is an intensive treatment you'll be monitored very closely throughout your stay in hospital. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
BEAM chemotherapy reduces the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. When the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia. You'll be given antibiotics to take as a preventative measure. These are known as prophylactic antibiotics.
You'll start to produce white blood cells after you have had your infusion of stem cells. They usually return to a safe level around 10–16 days later. To stimulate the number of white blood cells that your bone marrow produces, you may be given injections of a drug called G-CSF (granulocyte-colony stimulating factor). It's given as a daily injection under the skin (subcutaneously). The number of your white blood cells (blood count) will be checked by daily blood tests.
Your immune system will still be affected when your white blood cells are back to normal. To reduce your chances of getting an infection you'll need to continue taking antibiotics and anti-viral drugs for a while after you've left hospital.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
Bruising or bleeding
BEAM reduces the production of platelets, which help the blood to clot. You may have bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Your doctors will check the level of platelets in your blood by daily blood tests and give you platelets by drip (a transfusion) if needed. The number of platelets in your blood will usually return to a safe level around 14–20 days after you have had your stem cells. In some people it may take longer than this.
BEAM reduces the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Your level of red blood cells will be checked by daily blood tests and you'll be given blood transfusions as needed.
Anyone having a stem cell transplant should be given blood and platelet transfusions that have been treated with radiation (irradiated) indefinitely. This lowers the risk of the donated blood cells reacting against your own. Your hospital team should give you a card to carry or a Medicalert® to wear so that hospital staff are aware in case of an emergency.
Feeling sick (nausea) and being sick (vomiting)
You'll be given anti-sickness drugs regularly through your central line/PICC line or by mouth to prevent or reduce nausea and vomiting. There are different anti-sickness drugs; if one doesn't work for you there are other drugs your doctor can prescribe. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
You'll probably feel extremely tired. This is a very common side effect and it's important to allow yourself plenty of time to rest. You'll probably get tired easily and feel fairly weak for several more months after your treatment.
This usually starts about 6–8 days after your chemotherapy starts. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before treatment. Your nurse can give you advice about coping with hair loss.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Less common side effects
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BEAM can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Some people may get a rash on the hands and soles of the feet. This is caused by cytarabine and will usually go back to normal after treatment has finished. You may also have flushing of the skin, particularly when carmustine is being given.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF), and cover up with clothing and a hat.
Raised levels of uric acid in the blood
This can result in a condition called gout, which causes inflammation of the joints. To prevent this, you may be given a drug called allopurinol (Zyloric®) and you may be asked to drink plenty of fluids. While you're having BEAM you'll have regular blood tests to check your uric acid levels.
Cytarbine may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Let your doctor know so they can prescribe soothing eye drops if necessary.
You may develop flu-like symptoms a few hours after the treatment has been given. These include headaches, aching joints or muscles, a high temperature, lack of energy (lethargy) and chills. If this happens, it's important to drink plenty of fluids and get some rest. If these symptoms continue for more than a day contact your doctor.
BEAM can cause changes in the way your liver works, although your liver will return to normal when the treatment has finished. Your skin and the whites of your eyes may become yellow (jaundiced).
The doctor will take regular blood samples to check your liver is working properly.
Changes to the lungs
BEAM may cause some changes to the lung tissue. Tell your doctor if you smoke or if you notice any coughing or breathlessness.
Your kidneys could be affected
Melphalan can affect your kidneys. You'll have tests to check how well your kidneys are working before you have your treatment. During treatments your doctors will take regular blood samples to keep a careful check on how your kidneys are working.
Some people can have an allergic reaction. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, a headache and breathlessness. Tell your nurse or doctor straight away if you have any of these signs. A reaction can be treated quickly.
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.
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Risk of developing a blood clot
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it's important to tell your doctor straight away if you have any of these symptoms. Most clots can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Some other medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child will almost certainly be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Loss of periods in women
Due to the effect of chemotherapy on the ovaries women may find that their periods become irregular and may eventually stop. In younger women this may be temporary, but in older women they may stop permanently and they will have an early menopause. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness. Talk to your doctor or nurse if you get these symptoms.
It's not advisable to become pregnant or father a child while having BEAM as it may harm the developing baby. It's important to use effective contraception while taking these drugs and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Our information on stem cell transplants gives more detailed information and advice on what to expect during and after a stem cell transplant. It also gives advice on your recovery and what you can do to help yourself.
This section is based upon our BEAM chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.