BEAM

BEAM is the name of a combination of chemotherapy drugs. It includes the drugs we list below, next to each drug we have how you pronounce the drug name in brackets.

• B – Carmustine (car-mus-teen) also known as BCNU
• E – Etoposide (ee-top-o-side)
• A – Cytarabine (sye-ta-ra-bin) also known as Ara-C and cytosine arabinoside
• M – Melphalan (mel-fa-lan) also known as alkeran

It is a treatment for Hodgkin lymphoma and non-Hodgkin lymphoma. 

You usually have BEAM chemotherapy a week before a stem cell transplant.

Variations of BEAM

There are different variations of BEAM and this means that some people have lower amounts (doses) of drugs or different cancer drugs. Here are some of the different variations:

LEAM

When lomustine is used instead of carmustine the combination is called LEAM. Lomustine comes as capsules. Your doctor will tell you how much (dose), when and how to take it. 

Mini-BEAM

Mini-BEAM uses the same drugs as BEAM but at lower doses. 

Dexa-BEAM

This is the same as mini-BEAM with the steroid dexamethasone added to it. 

How does BEAM work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells as well as healthy cells from your bone marrow. 

How do you have BEAM?

You have BEAM as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

How often do you have BEAM?

You have BEAM just before you have a stem cell transplant. Doctors call the first day of BEAM treatment minus 6. They then count down to the day you have the stem cells which is called day 0.

You usually go into hospital the day before you start BEAM on day minus 7.

This is what BEAM treatment looks like:

You usually stay in hospital for about 2 to 3 weeks after your stem cell transplant. 

Tests

You have blood tests before, during and after your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of BEAM?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

A serious reaction to an infection (sepsis)

Signs include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Headaches and dizziness

Let your doctor or nurse know if you have headaches or feel dizzy. Your team can give you painkillers. 

Low blood pressure

Tell your doctor or nurse if you feel lightheaded or dizzy. You have your blood pressure checked regularly.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines, but it can be severe. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Diarrhoea and constipation

Tell your healthcare team if you have diarrhoea or constipation. They can give you medicine to help. 

Lung problems

You might develop a cough or breathing problems. This could be due to inflammation of the lungs (pneumonitis) or scarring or thickening of the lung. Rarely you might develop an infection, such as pneumonia. Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Eye problems

These drugs can cause eye problems such as blurred vision, sore or red eyes.

Less commonly, cytarabine can cause bleeding, watery, burning or stinging eyes. Your eyes might also move quickly from side to side (nystagmus) or be sensitive to light.

Tell your doctor or nurse if you have this as they might be able to prescribe eye drops to soothe them.

Sore anus 

Your anus could become inflamed, sore and develop ulcers. This can be painful. Contact your advice line or talk to your doctor or nurse if this happens. 

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after taking this drug.

Muscle pain and weakness

This drug can cause muscle pain or weakness in different parts of the body. Let your treatment team know so they can tell you what can help to reduce it.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Skin changes

You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

You might also have a feeling of warmth, tingling or both. This only lasts a little while.

A less common side effects are skin ulcers and reddening of the skin.

Cytarabine syndrome

This can happen about 6 to 12 hours after having cytarabine.

It is a combination of symptoms including a high temperature, aching muscles, bone pain, occasionally chest pain, a rash, sore eyes, and extreme weakness. You have steroids to help to prevent this syndrome. Contact your advice line or tell your doctor or nurse if this happens. 

High temperature

If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• a blood cancer such as acute leukaemia. Talk to your doctor if you are concerned about this.

• changes to your brain causing memory loss, personality changes and confusion. This can be serious. Contact the advice line or the healthcare team if you have any of these symptoms.

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness. Some allergic reactions can be life-threatening. Contact your treatment team alert your nurse or doctor if you notice any of these symptoms.

• changes to how the heart works including an irregular heartbeat, fast heartbeat or slow heartbeat and heart attack. You’ll be closely monitored when having this drug treatment.

• high blood pressure

• difficulty swallowing

• loss of appetite

• inflammation of the blood vessels

• kidney problems and difficulty passing urine. You have regular blood tests to check for this.

• inflammation at the injection site causing pain, redness and swelling. Tell your nurse straight away if you notice any of these symptoms.

Rare side effect

Nerve damage causing numbness and tingling in the feet and hands is a side effect that can happen in fewer than 1 in 100 people (fewer than 1%).

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

• Carmustine
• Etoposide
• Cytarabine
• Melphalan

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations 

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.