BEAM is a high-dose chemotherapy treatment. It is given before a stem cell transplant.
Treatment with high-dose chemotherapy destroys cancer cells in your bone marrow. You will then be given back your own stem cells as a drip into a vein. Stem cells are the earliest stage of blood cells. These stem cells will go into your bone marrow and begin to make new blood cells.
Some people may have BEAM chemotherapy in lower doses. This is known as mini-BEAM.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You will usually be given BEAM during a stay in hospital. Occasionally some people have BEAM as an outpatient. This is only suitable for some people. For example, people who live close to the hospital, or decide to stay in nearby hospital accommodation, may be able to have treatment as an outpatient.
A chemotherapy nurse will give your treatment. You have BEAM 1 week before you have the stem cell transplant.
During treatment you will see a cancer doctor, a blood specialist (haematologist), a chemotherapy nurse or a specialist nurse and a pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Your treatment will be given into a vein (intravenously). It can be given through:
- 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. The pump gives you the treatment over a set time. You will also be given extra fluids through a drip before and after you have melphalan. This is to protect your kidneys.
Your course of BEAM
You will have BEAM over 6 days.
A nurse will give you carmustine as a drip (infusion) over 1 to 2 hours.
Days 2, 3, 4 and 5
A nurse will give you:
- cytarabine twice a day as a drip over 30 minutes
- etoposide once a day as a drip over 2 hours.
A nurse will give you:
- melphalan as a drip over 30 minutes
- lots of fluids through a drip over several hours.
You will have the stem cells as a drip into your central or PICC line 24 hours after the melphalan has finished. Doctors call the day you are given stem cells Day 0. They may call the days before this day ‘minus days’ as they count down to the day you have your stem cells. For example, they may call day 6 ‘day minus 1’. Your nurse can explain this to you.
Mini-BEAM is given slightly differently. You have it over 5 or 6 days. After the treatment you will have a rest period. Your doctor will explain how long your rest period will be. This completes a cycle of your chemotherapy treatment. Each cycle takes 21 or 28 days (3 or 4 weeks). At the end of the 21 or 28 days, you start your next cycle of Mini-BEAM. This is the same as the first cycle. Your doctor or nurse will tell you the number of cycles you are likely to have.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.
Some people have an allergic reaction while having this treatment. Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless or wheezy
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction happens a few hours after treatment. If you develop any signs or feel unwell after you get home, contact the hospital straight away.
The drug leaks outside the vein
If the drug leaks outside the vein, it can damage the surrounding tissue. This is called extravasation. Extravasation is not common but if it happens it is important to treat it quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the contact telephone number they gave you.
Risk of infection
This treatment reduces the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
Your doctor will give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.
If you have an infection, it is important to treat it as soon as possible. If you are having treatment as an outpatient contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
G-CSF (granulocyte-colony stimulating factor) is a type of drug called a growth factor. It encourages the body to make more white blood cells.
Your doctor may give you G-CSF:
- if the number of white blood cells is very low
- to stop the number of white blood cells getting low.
You have it as a small injection under the skin.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
The nurses will give you anti-sickness drugs regularly to help prevent or control sickness during your treatment. If you feel sick or are sick (vomit), tell your nurse or doctor. They may change the anti-sickness drug to one that works better for you.
This treatment will make you feel very tired and you will need a lot of rest. You will get tired easily for some months after treatment has finished. Gentle exercise, like short walks, can give you more energy. The tiredness will slowly get better.If you feel sleepy, do not drive or use machinery.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
You will usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This is 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.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth and throat.
Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.
Loss of appetite
This treatment can affect your appetite. Your nurse or dietician will give you advice. They may give you food or drink supplements to take.
Effects on the eyes
This treatment may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to help prevent this. It is important to use these as you are told to.
This treatment may also make your eyes more sensitive to light and cause blurry vision. If you have pain or notice any change in your vision, always tell your doctor or nurse.
If you usually wear contact lenses, do not use them on the days you use eye drops or if your eyes are sore. Check with your doctor when it will be okay to use them again.
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. Cytarabine can cause a rash, which may be itchy. It may also cause your skin to become red or blistered.
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 will be more sensitive to the sun. Your skin may burn more easily than usual. You can still go out in the sun, but use a sun cream 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.
Effects on the kidneys
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 fluids. They will also give you extra fluids through a drip on the day you have melphalan. This is to protect your kidneys. If you pass urine (pee) less often than usual, tell your nurse.
Effects on the liver
Chemotherapy may affect how your liver works. This is usually mild and goes back to normal after treatment. But rarely it can cause yellowing of the whites of the eye or skin (jaundice). You will have blood tests to check how well your liver is working.
Effects on the heart
This treatment can affect how the heart works. You may have tests to see how well your heart is working. These may be done before, during and after treatment.
If the treatment is causing heart problems, your doctor may change the type of treatment you are having.
Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
- pain or tightness in your chest
- changes to your heartbeat.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. Your doctor or nurse can give you advice and 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. It will start to get better when treatment ends.
Tumour lysis syndrome (TLS)
This treatment causes cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid, but they may not be able to cope with large amounts. This can cause chemical imbalances in the blood that may affect the kidneys and the heart. This is called tumour lysis syndrome (TLS). You will have regular blood tests to check the uric acid levels.
Your doctor may give you drugs to help prevent TLS. Drinking at least 2 litres (3½ pints) of fluid a day will also help.
Cytarabine may cause some symptoms 6 to 12 hours after it has been given. This is called cytarabine syndrome. Signs can include:
- a high temperature or chills
- a rash
- pain in the eyes, bones, tummy or chest.
Tell your nurse or contact the hospital straight away if you have any of these symptoms.
Effects on the lungs
This treatment can cause changes to the lungs. Tell your doctor if you develop:
- a cough
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs.
Effects on the nervous system
BEAM can affect the nervous system. You may:
- feel drowsy
- feel confused
- feel dizzy or unsteady
- have pins and needles
- feel tingling in your arms and legs.
Tell your doctor or nurse straight away if you notice any of these symptoms.
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.
For a few months after your treatment, any blood or platelet transfusions you are given are first treated with radiation (irradiated). This is to prevent problems caused by white blood cells called lymphocytes, in the donated blood. Irradiated blood is not radioactive and will not harm you or anyone you come into contact with.
Some people may need any blood or platelet transfusions to be irradiated for the rest of their lives. Your doctor will talk to you about this. You will be given a medical alert card to carry in case you need blood in an emergency or at another hospital.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Some cancer drugs can affect whether you can get pregnant or make someone pregnant.
If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.
If you have sex during a course of chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.
After high-dose treatment, you may lose your immunity to illnesses you were vaccinated against as a child. You may need to have some of these vaccinations again.
Doctors also usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.
While your immune system is weak, you need to avoid live vaccinations. Your cancer doctor or GP can tell you more about live vaccinations.