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carmustine + etoposide + cytarabine + melphalan + antithymocyte globulin (commonly known as the BEAM/ATG regimen) is an intermediate-intensity, myeloablative conditioning regimen used prior to autologous hematopoietic stem cell transplantation (aHSCT). It is primarily utilized in patients with highly active, treatment-refractory relapsing-remitting or progressive multiple sclerosis (MS) to wipe out the autoreactive immune system before reinfusing harvested stem cells. The regimen combines the chemotherapy drugs carmustine, etoposide, cytarabine, and melphalan (BEAM) with antithymocyte globulin (ATG), an immunosuppressive polyclonal antibody. Carmustine and melphalan act as DNA alkylating agents, etoposide inhibits DNA topoisomerase II, and cytarabine inhibits DNA polymerase, collectively inducing severe myelosuppression and cell death in rapidly dividing cells. ATG provides targeted depletion of T-lymphocytes to eliminate autoreactive T-cell clones and prevent secondary autoimmune complications. This intensive combination therapy aims to reset the patient's immune system, allowing the transplanted stem cells to reconstitute a non-autoreactive immune system.
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