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 the 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 the type of cancer you have.

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. These 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.

BEAM is named after the initials of the chemotherapy drugs used, which are:

• B - BiCNU^® – carmustine
• E - etoposide
• A - Ara-C – cytarabine
• M - melphalan.

This treatment will be given to you in hospital. You will have BEAM a week before you have the stem cell transplant.

You will see a cancer doctor, a blood specialist (haematologist), a chemotherapy nurse or a specialist nurse during your treatment. This is who we mean when we mention doctor or nurse in this information.

Your treatment will be given into a vein (intravenously). It will be given through:

• a fine tube that goes under the skin of your chest and into a vein close by (central line)

or

• 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

You will have BEAM over six days before you have the stem cell transplant.

Day one

A nurse will give you carmustine as a drip (infusion) over one to two hours.

Days two, three, four and five

A nurse will give you:

• cytarabine twice a day as a drip over 30 minutes
• etoposide once a day as a drip over two hours.

Day six

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. Because of this 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.

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 haven’t 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.

More information

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 may have side effects while they are being given the chemotherapy or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

• feeling hot or flushed 
• a skin rash
• itching
• shivering
• feeling dizzy
• a headache
• feeling breathless 
• 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 can happen a few hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.

The drug leaks outside the vein

If this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens, it is important that it is dealt with 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 number they gave you.

Risk of infection

Chemotherapy can reduce 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 may 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. 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
• diarrhoea
• needing to pass urine often.

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. Tell your doctor if you have any bruising or bleeding that you cannot explain. This includes:

• nosebleeds
• bleeding gums
• tiny red or purple spots on the skin that may look like a rash.

Some people may need a drip to give them 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. 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. This is called a blood transfusion.

Feeling sick

You may feel sick 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.

Feeling tired

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 too. Gentle exercise, like short walks, can give you more energy. The tiredness will gradually get better.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Hair loss

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 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

You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

If your mouth 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.

Loss of appetite

This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.

Eye problems

This treatment may make your eyes feel sore, red and itchy (conjunctivitis). Your doctor will prescribe eye drops to help prevent this. Your pharmacist will tell you how to use your eye drops. It is important to follow their advice.

It 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.

Skin changes

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 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.

Soreness and redness of palms of hands and soles of feet

This is called palmar-plantar or hand-foot syndrome. It gets better when your treatment ends. 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.

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 fluids. Tell them if there are any changes in how much urine you are producing.

Changes in the way the liver works

This treatment can change the way your liver works. This will usually go back to normal after treatment finishes. Rarely, 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.

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 to 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 instead.

Reaction to cytarabine

Cytarabine may cause a reaction 6 to 12 hours after it has been given. Signs of a reaction can include:

• a high temperature or chills
• a rash
• pain in the eyes, bones, tummy or chest.

Tell your nurse 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
• wheezing
• a fever (high temperature)
• breathlessness.

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, 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.

Second cancer

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.

Blood irradiation

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 and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:

• pain, redness or swelling in a leg or arm
• breathlessness
• chest pain. 

If you have any of these symptoms, contact a doctor straight away. 

A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.

Alcohol

This treatment contains alcohol. If this is a problem for you, tell your doctor, nurse or pharmacist. Your blood alcohol level may be above the legal limit after you have the treatment. It is best not to drive or operate machinery for a few hours after having this treatment, even if you feel okay.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Fertility

Some chemotherapy drugs can affect whether you can get pregnant or father a child.

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.

There may be ways to preserve fertility for men and women. If you are worried about fertility, it is important to talk with your doctor before you start chemotherapy treatment.

Sex

If you have sex during this 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 that 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.