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regimen-monograph
MINIBEAM
Intent
Curative
Regimen Category
Evidence-Informed
Drugs Used
A - Regimen Name
MINIBEAM Regimen
BCNU (Carmustine)-Etoposide-ARA-C (Cytarabine)-Melphalan
Disease Site
Hematologic - Lymphoma - Non-Hodgkin's (Salvage Therapy - Aggressive Histology)
Intent
Curative
Regimen Category
Evidence-Informed :
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
Rationale and Uses
Salvage therapy of agressive histology Non-Hodgkin’s Lymphoma. Preparatory regimen before high dose treatment with bone marrow/stem cell rescue.
B - Drug Regimen
| carmustine
(Round to nearest 3 mg) |
60 mg /m² | IV | Day 1 |
|
|
|||
| etoposide
(Round to nearest 10 mg) |
75 mg /m² | IV | Days 2 to 5 |
| cytarabine
(Round to nearest 10mg) |
100 mg /m² | IV | q12h Days 2 to 5 |
|
(continued on next page)
|
|||
| melphalan
(Round to nearest 5mg) |
30 mg /m² | IV | Day 6 |
|
(May give 6 mg/m2 IV daily for 5 days, or entire dose on Day 6, for inpatient administration) |
|||
C - Cycle Frequency
REPEAT EVERY 4 to 6 WEEKS
Repeat treatments when adequate marrow recovery, until desired response
D - Premedication and Supportive Measures
Antiemetic Regimen:
Moderate
Febrile Neutropenia Risk:
High
Other Supportive Care:
Also refer to CCO Antiemetic Summary
Treatment with filgrastim following completion of chemotherapy; treatment until AGC ≥ 5 x 109/L - Optional adjunct at discretion of prescriber.
E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are based on product monographs.
Dosage with toxicity
Hematologic Toxicities
See Appendix 6 for general recommendations. No dose reductions, consider prophylactic administration of filgrastim.
Hepatic Impairment
|
Bilirubin
|
% usual dose
|
|
>1-2 ULN
|
REDUCE Etoposide to 50% dose
|
|
>2-4 ULN
|
REDUCE Etoposide to 25% dose
|
|
>4 ULN
|
OMIT Etoposide dose
|
|
|
|
Carmustine: Dosage adjustment may be necessary; no specific recommendations found.
Renal Impairment
|
Creatinine Clearance
|
% usual dose
|
|
0.2-0.8mL/sec*
|
REDUCE Melphalan to 75% dose
REDUCE Etoposide to 75% dose
|
|
< 0.2mL/sec
|
DISCONTINUE Carmustine
REDUCE Etoposide to 50% dose
REDUCE Melphalan to 50% dose
|
|
* No recommendations found for carmustine
|
|
F - Adverse Effects
Refer to carmustine, etoposide, cytarabine, melphalan drug monograph(s) for additional details of adverse effects
| Most Common Side Effects | Less Common Side Effects, but may be |
|
|
G - Interactions
Refer to carmustine, etoposide, cytarabine, melphalan drug monograph(s) for additional details
H - Drug Administration and Special Precautions
Refer to carmustine, etoposide, cytarabine, melphalan drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.
Recommended Clinical Monitoring
- CBC; baseline and before each cycle. Interim counts should be done in first cycle and repeated if dose modifications necessary.
- Baseline and regular liver function tests.
- Baseline and regular renal function tests and urinalysis.
- Baseline and routine pulmonary function tests and clinical pulmonary exam before each cycle.
- Clinical toxicity assessment (including stomatitis, gastrointestinal, local toxicity, pulmonary); at each visit
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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J - Administrative Information
Approximate Patient Visit
Day 1: 1-2 hours; Days 2-5: 2 hours; Day 6: 0.5 hour
K - References
Carmustine, etoposide, cytarabine, melphalan drug monographs, Cancer Care Ontario.
Martin A, Fernandez-Jimenez MC, Caballero MD et al. Long-term follow-up in patients treated with Mini-BEAM as slavage therapy for relapsed or refractory Hodgkin’s disease. Br J Haematol 2001 Apr; 113(1): 161-71.
Moore S, Kayani I, Peggs K, et al. Mini-BEAM is effective as a bridge to transplantation in patients with refractory or relapsed Hodgkin lymphoma who have failed to respond to previous lines of salvage chemotherapy but not in patients with salvage-refractory DLBCL. Br J Haematol. 2012 Jun;157(5):543-52.
October 2017 Replaced regimen category with evidence-informed
L - Other Notes
The Mini-BEAM regimen may be used as a preparatory regimen in advance of a bone marrow or peripheral stem cell regimen.
This regimen should ONLY be administered by clinicians familiar with the adverse effects of Mini-BEAM, and with the hospital services to support each patient.
Mini-BEAM has a high risk of febrile neutropenia with each cycle (including the first cycle; FILGRASTIM should be used following each chemotherapy cycle).
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 27, 2026
