BEAM

Say it: BEEM (like a beam of light)

Carmustine, etoposide, cytarabine and melphalan

BEAM is high dose chemotherapy given in the hospital right before an autologous stem cell transplant (using your own stem cells) for lymphoma.

Also called: BEAM conditioning, BEAM chemo, BEAM before transplant, high dose chemotherapy and autologous stem cell transplant, BeEAM, HDT ASCT

What it is

BEAM uses much higher doses of chemotherapy than usual to kill as many lymphoma cells as possible. These doses also wipe out the bone marrow, so your own stem cells, collected and frozen weeks earlier, are given back afterward to rebuild it. This is called conditioning, and the goal is cure or long lasting control. Your stem cells are given back like a blood transfusion on the day called day 0.

Often used for

• Hodgkin lymphoma that came back or did not respond to first treatment
• Non-Hodgkin lymphoma that came back, such as diffuse large B-cell lymphoma
• First remission of some lymphomas, such as mantle cell or T-cell lymphoma

BeEAM

Bendamustine is used in place of carmustine. Some centers use it to avoid carmustine lung effects or during carmustine shortages.

Other conditioning plans

Plans such as CBV, LEAM or TEAM use different medicines for the same purpose. Your transplant team picks the plan that fits you.

The medicines in this plan

Carmustine (BCNU)

An alkylating chemotherapy. Given through a vein over about 2 hours once, about 6 days before the transplant.

Etoposide

Chemotherapy given through a vein, usually once or twice a day for 4 days.

Cytarabine (Ara-C)

Chemotherapy given through a vein twice a day for 4 days. Steroid eye drops are often used to protect the eyes.

Melphalan

An alkylating chemotherapy. Given through a vein once, the day before your stem cells are returned.

How you get it

BEAM is given during a hospital stay, usually about 3 to 4 weeks, in a transplant unit. Chemotherapy is given over 6 days, then your stem cells are returned on day 0. You stay until your blood counts recover, often around 10 to 14 days after the transplant, and you can eat and drink well. This is a one time treatment, not repeating cycles. Your schedule may be different.

A typical cycle

Weeks before

Tests of your heart, lungs and kidneys. Your stem cells are collected from your blood and frozen.

Day minus 6

Admission and IV carmustine.

Days minus 5 to minus 2

IV etoposide and twice daily IV cytarabine, with eye drops and nausea medicines.

Day minus 1

IV melphalan. Sucking on ice chips during the infusion helps prevent mouth sores.

Day 0

Your thawed stem cells are given back through your central line, like a transfusion.

Days 1 to 21

Blood counts drop very low and then recover. Transfusions, antibiotics and close care until counts return and you can go home.

Common side effects and what helps

• Very low blood counts for 1 to 2 weeks. Fevers are common and are treated right away with IV antibiotics.
• Painful mouth and throat sores. Ice chips during melphalan, gentle rinses and pain medicines help.
• Nausea, vomiting and poor appetite. Medicines are given around the clock, and IV nutrition may be used for a short time.
• Diarrhea. Tell your nurse so stool can be checked for infection.
• Hair loss, usually complete. It grows back in a few months.
• Deep tiredness that can last weeks to months after you go home. Build activity back slowly.
• A garlic or creamed corn smell or taste on day 0 from the preservative in the frozen stem cells. It passes in a day or two.
• Red, irritated eyes from cytarabine. Use the eye drops exactly as scheduled.
• Need for blood and platelet transfusions until your marrow recovers.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• A new dry cough or shortness of breath, even weeks or months after transplant (carmustine can affect the lungs late)
• Bleeding, black stools or many new bruises
• Diarrhea or vomiting that keeps you from drinking
• Redness, pain or drainage around your central line
• Confusion, a severe headache or fainting
• Trouble swallowing liquids or pain medicines not controlling mouth pain

Good to know

• This is high dose treatment given in the hospital right before an autologous stem cell transplant. You need your own stem cells collected first.
• Lung function tests are done before BEAM, and your lungs are watched afterward, since carmustine can cause lung inflammation weeks to months later.
• You will get medicines to prevent bacterial, viral and fungal infections.
• Childhood vaccines usually need to be given again starting several months after transplant.
• This treatment usually causes infertility. Ask about sperm or egg banking before starting.
• There is a small long term risk of a second blood cancer after transplant.

At home

• Take your temperature twice a day for the first weeks home, and call for a fever.
• Wash hands often, avoid crowds and sick people, and follow your center's food safety rules.
• Keep taking your infection prevention medicines exactly as prescribed.
• Have a caregiver available, often 24 hours a day for the first weeks.
• Build up activity slowly with short daily walks.

Questions to ask

• Why is a transplant the right step for me now?
• How long will I be in the hospital?
• How will my stem cells be collected?
• What help will I need from a caregiver at home?
• When can I go back to work, school or normal activities?
• How will we know if the transplant worked?

Lymphoma

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.