BEAM Chemotherapy

BEAM is a treatment for Hodgkin lymphoma and non Hodgkin lymphoma. You have BEAM chemotherapy as part of a stem cell transplant, in my case following ESHAP salvage chemotherapy. BEAM consists of 4 drugs:

  • B – Carmustine (BiCNU) or Lomustine (CCNU)
  • EEtoposide
  • A – Cytarabine (Ara-C, cytosine arabinoside)
  • MMelphalan

You are given the drugs into your bloodstream intravenously through a central line (or and apheresis line in my case which is just a bit thicker), a portacath or a PICC line. All are basically long, plastic tubes that go directly into a large vein in your chest.

How you have BEAM

  • Day 1: carmustine as a drip, usually over 2 hours
  • Day 2,3,4 & 5: you have cytarabine as a drip twice a day over 30 minutes. And you have etoposide as a drip once a day over 2 hours. Some hospitals give the cytarabine as a single dose
  • Day 6: melphalan as a drip over 15 to 30 minutes and another drip to give you extra fluids
  • Day 7 (also known as day 0): At least 24 hours after the melphalan you have your stem cells put back into your body

Common side effects of BEAM

One or more of the following happen to more than 10% of people:

  • An increased risk of getting an infection from a drop in white blood cells. Also headaches, aching muscles, a cough, a sore throat, pain passing urine, or fevers. Severe infections can be life threatening so best let your hospital team know straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to anaemia (a drop in red blood cells).
    Diarrhoea is very common and affects 80% of people. Drugs can help to control it.
  • Stomach pain
  • Bruising more easily due to a drop in platelets as well as nosebleeds or bleeding gums after brushing teeth. Another symptom to watch out for is tiny red spots or bruises on arms or legs (petechia). You may need to have platelets in a drip. It usually takes about 3 to 4 weeks for the number of platelets to get to a safe level again
  • Sore mouth and mouth ulcers. 75% of people have very sore mouths and need to have painkillers. Mouthwashes help to keep the mouth clean and if it gets really sore you may need to be drip fed
  • Nausea and vomiting – but you will be given anti sickness medicines regularly to combat this
  • Tiredness, extreme fatigue and weakness affects most people both during and after treatment. It can take 6 months to a year for energy levels to get back to normal
  • Hair loss: most people have complete hair loss but hair will grow back once treatment ends
  • Taste changes
  • Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (plantar-palmer syndrome). This may cause tingling, numbness, pain and dryness
  • Loss of appetite
  • Lung problems: a cough or breathlessness happens in up to 30% of people (due to inflammation of the lungs)
  • Women may temporarily stop having periods (amenorrhoea)
  • Loss of fertility

Less common side effects of BEAM

  • Allergic reactions while having treatment
  • Kidney function changes
  • Increased uric acid levels in the blood

Very rare side effects include:

  • Liver function changes during and just after treatment which should go back to normal in time
  • As with most chemo there is an increased risk of developing a second cancer years later

None of this sounds very pleasant but a lot of these can be treated to ease discomfort. For instance, the sore mouth, which I hear is the worst of the side effects, can be avoided by sucking ice lollies constantly during and after taking Melphalan.

The above info I have compiled from various other websites and literature I have been given by the hospital. I will update this page once I have been through this personally, as I know too well from ABVD and ESHAP that everyone reacts differently to each chemo regimen. I have seen someone on the Ambulatory ward who had just finished BEAM and came in for his stem cells. Looked like a bit of a non-event to be honest (the stem cells going back in) but the guy didnt look too chuffed with life I have to say. Was probably in a lot of discomfort (he didn’t look very chatty!).

Hopefully by the time this page is updated I will have been through it and be well on my way to getting my immune system back and getting out of hospital!