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Treatment Name: BEAM (Carmustine + Etoposide + Cytarabine + Melphalan)

BEAM (Carmustine + Etoposide + Cytarabine + Melphalan) is a Chemotherapy Regimen for Autologous Stem Cell Transplant (autoSCT)

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References

1) Chopra R, McMillan A, Linch D, et al. The place of high-dose BEAM therapy and autologous bone marrow transplantation in poor-risk Hodgkin's disease. A single-center eight-year study of 155 patients. Blood 1993;81:1137-1145

2) Mills W, Chopra R, McMillan A, et al. BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin's lymphoma. J Clin Oncol 1995;13:588-595

3) Caballero MD, Rubio V, Heras I, et al. BEAM chemotherapy followed by autologous stem cell support in lymphoma patients: analysis of efficacy, toxicity and prognostic factors. Bone Marrow Transplant 1997;20:451-458

4) Jo J, Kang B, Jang G, et al. BEAC or BEAM high-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin's lymphoma patients: comparative analysis of efficacy and toxicity. Ann Hematol 2008;87:43-48

5) Wang E, Chen Y, Corringham S, et al. High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma. Bone Marrow Transplant 2004;34:581-587

Created: March 19, 2020 Updated: March 19, 2020

What is Autologous Stem Cell Transplant (autoSCT)?

Autologous stem cell transplant or "bone marrow transplant" is a type of stem cell transplant in which a patient’s own stem cells are collected prior to administration of high-dose chemotherapy, or a combination of high-dose chemotherapy agents, with or without radiation.

High-dose chemotherapy is designed to kill more cancer cells, but it also destroys normal blood-producing cells in the bone marrow. Because of this, previously collected stem cells are infused after high-dose chemotherapy to allow the bone marrow to recover blood cell production faster and can prevent a potentially life-threatening infection from occuring.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose your therapy.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common BEAM starting doses

  • Carmustine 300 mg/m2 intravenous infusion over 2 hours on day -6 prior to stem cell infusion
  • Etoposide 100-200 mg/m2 intravenous infusion over 1 to 2 hours once or twice daily on days -5 to -2 prior to stem cell infusion
  • Cytarabine 100-200 mg/m2 intravenous infusion over 1 hour twice daily on days -5 to -2 prior to stem cell infusion
  • Melphalan 140 mg/m2 intravenous infusion over 15 to 30 minutes on day -1 prior to stem cell infusion

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability.

BEAM clinical trials

1) Chopra R, McMillan A, Linch D, et al. The place of high-dose BEAM therapy and autologous bone marrow transplantation in poor-risk Hodgkin's disease. A single-center eight-year study of 155 patients. Blood 1993;81:1137-1145

2) Mills W, Chopra R, McMillan A, et al. BEAM chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-Hodgkin's lymphoma. J Clin Oncol 1995;13:588-595

3) Caballero MD, Rubio V, Heras I, et al. BEAM chemotherapy followed by autologous stem cell support in lymphoma patients: analysis of efficacy, toxicity and prognostic factors. Bone Marrow Transplant 1997;20:451-458

4) Jo J, Kang B, Jang G, et al. BEAC or BEAM high-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin's lymphoma patients: comparative analysis of efficacy and toxicity. Ann Hematol 2008;87:43-48

5) Wang E, Chen Y, Corringham S, et al. High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma. Bone Marrow Transplant 2004;34:581-587

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What does engraftment mean?

Engraftment is when the new blood-producing cells start to multiply in the bone marrow and appear the blood. White blood cell engraftment usually occurs first, prior to platelet or red blood cell engraftment, and is associated with the healing of mouth sores, resolution or abatement of nausea and neutropenic fever.

What is TPN?

Total Parenteral Nutrition (TPN) is the process of administering required nutrition intravenously, bypassing the normal process of food digestion in the gastrointestinal tract. It frequently consists of glucose, lipids, amino acids, electrolytes, vitamins, and minerals.

What is a conditioning regimen?

A conditioning regimen is a form of treatment used to prepare a patient for stem cell transplant. Conditioning regimens are used to make room in the bone marrow for new white blood cells, red blood cells and platelets to grow. They also help eliminate or kill any residual cancer cells and ensures that the body does not reject the newly infused stem cells. It often includes chemotherapy, monoclonal antibody, total body irradiation, or their combination.