Side effects of BEAM
Find out about the side effects of the chemotherapy drug combination: carmustine, etoposide, cytarabine and melphalan (BEAM) for Hodgkin lymphoma.
Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Common side effects
Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.
You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.
You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.
Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you.
Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.
Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.
Diarrhoea affects 8 out of 10 people (80%).
Speak to your doctor or nurse if you have stomach pain.
You might notice you:
- bruise more easily
- have nosebleeds
- have bleeding gums when you brush your teeth
This is due to a drop in the number of platelets that help clot your blood.
If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called 
.
Tell your doctor or nurse straight away if you have this.
You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away.
Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.
Tips
- Keep your hands and feet warm.
- Wear well fitting, protective shoes.
- Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
- Use oven gloves when cooking and protective gloves when gardening.
- Moisturise your skin at least a couple of times a day.
- Take care when cutting your nails.
Your mouth might become sore about 5 to 10 days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.
Your doctor or nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.
Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.
Tips
- Clean your mouth and teeth gently every morning and evening and after each meal.
- Use mouthwashes as advised by your doctor or nurse. Let them know if the mouthwash stings. They can tell you to stop using it or dilute it with water.
- Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
- Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
- Moisten meals with gravies and sauces to make swallowing easier.
- Avoid acidic fruits such as oranges, grapefruit or lemons.
3 out of 4 people (75%) have very sore mouths and need to have painkillers. You may also need to have a drip to feed you (total parenteral nutrition or TPN).
Anti sickness medicines can usually help to control this. There are different types of anti sickness medicine and they work in different ways.
Tell your doctor or nurse if you still feel sick so they can find a medicine that’s right for you. Tell them what helps and what makes the sickness worse.
Sickness is sometimes caused by fluid building up in the stomach. Putting a tube into the stomach to drain this fluid can ease the sickness and help you feel better.
Tips to reduce sickness
- Eat several small meals and snacks each day if possible.
- Don't drink much just before eating.
- Relaxation techniques help some people control their sickness.
- Ginger can help - try it as crystallised stem ginger, ginger tea or ginger ale.
- Peppermint can help - use a few drops of peppermint oil on a diffuser, you can also try peppermint tea or sucking on mint.
- Try sipping fizzy drinks.
- Drink high calorie drinks if you can't eat.
You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.
You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.
Talk to your doctor or nurse if you are finding the tiredness difficult to manage.
You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.
Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.
Tips
- Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
- You could choose a wig for a whole new look.
- Think about having your hair cut short before your treatment starts.
- Some people shave their hair off completely so they don't have to cope with their hair falling out.
- Wear a hairnet at night so you won't wake up with hair all over your pillow.
Changes in taste can make you go off certain foods. Many people go off tea and coffee, for example. You might also find that some foods taste different. Some people find that they prefer to eat spicier foods.
Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.
Tips
- Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
- Season your food with spices or herbs, such as rosemary, basil and mint.
- Garnish cold meat or cheese with pickle or chutney.
- Try lemon or green tea if tea or coffee taste strange.
- Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
- Some people find that cold foods taste better than hot foods.
The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome. Tell your doctor or nurse if this happens.
Tips
- Keep your hands and feet cool.
- Avoid very hot water.
- Don't wear tight fitting gloves or socks.
- Moisturise your skin with non perfumed creams.
- Take vitamin B6 (pyridoxine), which your doctor or nurse can prescribe.
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.
Tips
- Eating several small meals and snacks throughout the day can be easier to manage.
- Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
- You can make up calories between treatments for the days when you really don’t feel like eating.
- Drink plenty of fluids even if you can't eat.
- Don't fill your stomach with a large amount of liquid before eating.
- Try to eat high calorie foods to keep your weight up.
Tell your doctor or nurse if you develop a dry cough or breathlessness, especially in cold weather.
A cough or breathlessness can happen in up to 1 in 3 people (30%).
Women might stop having periods (amenorrhoea) but this may be temporary.
Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men
You may be able to store sperm before starting treatment.
It can take a few months or sometimes years for fertility to return to normal. You can have sperm counts to check your fertility when your treatment is over. Ask your doctor about it.
Women
Chemotherapy can cause an early menopause. This stops you from being able to become pregnant in the future. Talk to your doctor about this before your treatment. It’s sometimes possible to store eggs or embryos before treatment.
Occasional side effects
Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.
High levels of uric acid in your blood can lead to a build up of crystals in body tissues and cause inflamed joints. You’ll have regular blood tests to check your levels. Drinking plenty of fluids helps to flush out the excess uric acid. You might also have medicines to control the uric acid levels.
Some drugs can affect the way your kidneys work. You'll have regular blood tests to check how well your kidneys are working.
You are unlikely to notice any symptoms from this and any changes will almost certainly go back to normal after treatment.
This usually happens with the first or second treatment. Symptoms include a skin rash, itching, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.
Rare side effects
Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.
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.
There is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you.
About BEAM chemotherapy
More information about this treatment
We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.
You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
