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This information is about a high-dose chemotherapy treatment called BEAM. It is given before a stem cell or bone marrow transplant for Hodgkin lymphoma and non-Hodgkin lymphoma (cancers of the lymphatic system). A stem cell or bone marrow transplant allows you to have much higher doses of chemotherapy, which can improve the chances of curing your cancer.
It describes the drugs used, how they’re given and some of the possible side effects.
Treatment with high-dose chemotherapy destroys cancer cells in your bone marrow but it also destroys your healthy stem cells (early blood cells found in the bone marrow). To help you make new blood cells, your own or a donor's stem cells are collected before your high-dose chemotherapy and given back to you after it. The stem cells find their way to the bone marrow where they start to make new blood cells.
BEAM is named after the initials of the chemotherapy drugs used. These are:
This treatment is given to you while you are in hospital. The treatment is usually given over a period of eight days. After this you will be given your own or your donor's stem cells. You will need to stay in hospital until your blood cells have recovered to a safe level and you are 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 are admitted to hospital. You will be seen by a doctor, and may also see a specialist nurse or pharmacist. If the results of your blood test 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) through a thin plastic tube that is inserted under the skin into a vein near the collar bone (central line). Your doctor or nurse will explain more about this to you. Your drip will be run through an infusion pump which controls the flow of fluid into your vein.
You will be given anti-sickness (anti-emetic) drugs either by mouth or by injection through your central line.
The treatment is given over a period of eight days. You only have chemotherapy on six of those days. The first day is usually called Day Minus 7, which is a count down to having the stem cell infusion on Day 0.
Before and after treatment with BEAM you will be given lots of fluids through your drip to keep your kidneys working normally.
Each person’s reaction to high-dose chemotherapy is different. Not all of the side effects described in this information will affect everyone who is given BEAM. There are a lot of things that can be done to help reduce or control the side effects that you have.
We have outlined the most common side effects so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore unlikely to affect you.
Because this is an intensive treatment you will be monitored very closely throughout your stay in hospital. Let your doctor or nurse know straightaway if you notice any effects that you think are due to your treatment.
Lowered resistance to infection BEAM chemotherapy reduces the production of white blood cells (which fight infections) by the bone marrow. This means you are very prone to infection. You'll be given antibiotics to take as a preventative measure. This is known as prophylactic antibiotics.
You will start to produce white cells after you have had your infusion of stem cells. They usually return to a safe level around 10–16 days later. To boost 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 is given as a daily injection under the skin (subcutaneously). Your doctors will check your level of white cells by daily blood tests.
Your immune system will still be affected when your white cells are back to normal. To reduce your chances of getting an infection you will need to continue taking antibiotics and anti-viral drugs for a while after you've left hospital.
Bruising or bleeding BEAM reduces the production of platelets, which help the blood to clot. You may have bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums. 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 level 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.
Anaemia (low number of red blood cells) BEAM reduces the number of red blood cells, which makes you anaemic. This may make you feel tired and breathless. Your level of red cells will be checked by daily blood tests and you will be given blood transfusions as needed.
Feeling sick (nausea) and being sick (vomiting) You will be given anti-sickness drugs regularly (into your central line or by mouth) to prevent or reduce nausea and vomiting. There are different anti-sickness drugs, so if one doesn't work for you there are other drugs your doctor can prescribe. Some anti-sickness drugs may cause constipation.
Diarrhoea If you have diarrhoea your doctor can prescribe medicine to help control it. Try and drink plenty of fluids if you can.
Tiredness You will probably feel extremely tired during this treatment. This is a very common side effect and it is important to try and get as much rest as you need. You will probably get tired easily and feel fairly weak for several more months after your treatment.
Hair loss This usually starts about 6–8 days after your chemotherapy starts. Usually all your hair will fall out. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished.
Sore mouth and ulcers (mucositis) BEAM usually causes a sore mouth and mouth ulcers. Your nurse will show you how to look after your mouth while you're in hospital. You'll be given special mouthwashes, medicines to prevent or to treat mouth infections, and painkillers to relieve any pain.
Taste changes You'll probably notice that food tastes different. Normal taste will usually come back after the treatment finishes. Sometimes it may take up to a couple of months for this to happen.
Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.
Skin changes BEAM can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. You may also have flushing of the skin, particularly when carmustine is being given.
During the treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor sun cream and cover up with clothes.
Soreness and redness of the palms of the hands and soles of the feet (Sometimes known as palmar plantar or hand and foot syndrome). This can be caused by cytarabine. It will improve when the treatment is finished.
Raised levels of uric acid in the blood Some chemotherapy drugs can cause this to happen. Too much uric acid can result in a condition called gout which causes inflammation of the joints. To prevent this from happening you may be given a drug called allopurinol. Your uric acid levels will be check by blood tests.
Gritty eyes due to inflammation of the lining of the eyelids (conjunctiva) This may happen due to cytarabine. If it does you will be prescribed soothing eye drops.
A flu-like effect This can happen after cytarabine is given, and may last for a few days. You may feel as if you have no energy, have headaches, aching joints or muscles, chills and a temperature.
Sleeplessness, headaches and confusion Etoposide in high doses can cause these effects. Let your doctor or nurse know straightaway if you notice any of these.
Your liver may be temporarily affected BEAM can cause changes in the way that 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 have a cough or feel breathless.
Your kidneys could be affected Melphalan can affect your kidneys. You will have tests to check how well your kidneys are working before you have your treatment. During treatment your doctors will take regular blood samples to keep a careful check on how your kidneys are working.
Allergic reaction Some people can have an allergic reaction. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, headache and breathlessness. Let your nurse or doctor know straightaway if you have any of these symptoms. A reaction can be treated quickly.
Risk of blood clots 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 is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs to thin the blood. Your doctor or nurse can give you more information.
Mini-BEAM Some patients 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.
Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child is likely to be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.
Loss of periods in women Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular or even stop. In younger women this may be temporary, but if you are older they may stop permanently and you 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.
Contraception It’s not advisable to become pregnant or father a child while having BEAM, as the developing foetus may be harmed. 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.
Our section on stem cell and bone marrow 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 factsheet which has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography.
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