Canterbury DHB

BEAM Detailed Schedule

Carmustine (BCNU)

• Carmustine is administered at a dose of 300 mg/m² IV on day –6. It is dissolved in 250 ml of D5W in a glass container and given over 2 hours.
• Local practice is to dilute carmustine in a glass container immediately after reconstitution. When this is done the drug is stable for 8 hours at room temperature under normal indoor lighting and therefore does not require protection from light.
• Carmustine may also be diluted in a greater volume of 5% dextrose or 0.9% saline in a PVC bag, however expiry is significantly reduced, ie 2 hours.
• Due to the risk of hypotension, patients should be supine while receiving carmustine. Check vital signs regularly, and advise patients to rise slowly prior to mobilising.
• Adverse effects include nausea and vomiting, diarrhoea, reversible hepatic toxicity, flushing of the skin with rapid IV infusion and pulmonary toxicity.

Etoposide phosphate

• Etoposide phosphate is administered at a dose of 200 mg/m² IV from day -5 until day -2 inclusive (a total of 4 doses). It is dissolved in 200 ml normal saline and given over 30 minutes.
• Adverse effects include malaise, muscle weakness, nausea and vomiting, mucositis, reversible alopecia, transient hypotension following rapid IV administration and anaphylactic-like reactions. (The latter usually responds to stopping the infusion and the administration of an antihistamine and hydrocortisone.)

Cytarabine (ARA-C Cytosine Arabinoside)

• Cytarabine is administered at a dose of 200 mg/m² IV q12h from day -5 until day -2 inclusive (a total of 8 doses). It is dissolved in 100 ml normal saline and given over 30 minutes.
• Adverse effects include nausea and vomiting, diarrhoea, oral ulceration, hepatic dysfunction and fever. A cytarabine syndrome has been described. It is characterised by fever, myalgia, bone pain, occasional chest pain, maculopapular rash, conjunctivitis and malaise. It usually occurs 6 to 12 hours following administration of doses higher than those used in this schedule.

Melphalan

Melphalan is given on day –1, at a dose of 140 mg/m² by slow IV bolus over no more than 30 minutes, into fast running saline. Melphalan is unstable in solution and its administration should be planned with pharmacy cytotoxics. Melphalan decomposes, and the rate of decomposition increases with increased temperature. It must be used immediately after making up, once reconstituted. It must be protected from light and it cannot be scheduled on Sunday or public holidays.

Adverse effects include nausea and vomiting, severe mucositis, pulmonary fibrosis (rarely). Hyperhydration is necessary prior to and after administration (see Melphalan IV Fluids chart).

Fluid retention and electrolyte imbalances are common during this conditioning schedule. Extra doses of frusemide are usually sufficient to treat fluid retention. Allopurinol is given to prevent urate nephropathy at a dose of 300 mg PO daily (adult dose). It is commenced on admission and continued until day -1. If vomited it should be readministered.

The antiemetics of choice are ondansetron (8 mg PO/IV q12h for adults) and dexamethasone 8 mg daily BD.

At least 24 hours must elapse after melphalan administration before stem cells are reinfused.

Adjustment for renal insufficiency. If there is renal impairment, discuss with the Consultant.

*Discuss the advisability of proceeding with the SCT with the Consultant.

Topic Code: 12606