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Lomustine + etoposide + cytarabine + melphalan (LEAM) is a high-dose chemotherapy conditioning regimen used prior to autologous hematopoietic stem cell transplantation (auto-HSCT) in patients with relapsed or refractory Hodgkin lymphoma and Non-Hodgkin lymphoma. Developed as an alternative to the standard BEAM regimen (which contains carmustine instead of lomustine) to mitigate carmustine shortages and potential pulmonary toxicities, LEAM consists of four generic cytotoxic chemotherapy agents. Lomustine is an oral nitrosourea that acts as a DNA alkylating agent; etoposide is an inhibitor of topoisomerase II; cytarabine is an antimetabolite that interferes with DNA synthesis; and melphalan is an intravenous alkylating agent. The regimen is typically administered in hospital or transplant center settings to eradicate residual cancer cells and ablate the bone marrow before stem cell rescue.
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