This information is about a chemotherapy treatment for non-Hodgkin lymphoma called PMitCEBO.
The drugs that are used
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PMitCEBO is named after the initials of the drugs used, which are prednisolone (a steroid) and the following chemotherapy drugs:
How treatment is given
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PMitCEBO chemotherapy is usually given to you as a day patient. Before you start treatment you'll need to have a blood test on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist.
If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
Prednisolone is given to you as a tablet. The chemotherapy drugs are given into a vein (intravenously) either as a drip (infusion) or as an injection. They are given in one of the following ways:
through a fine tube (cannula) inserted into a vein (intravenously), usually in the back of your hand
through a fine, plastic tube inserted under the skin and into a vein near your collarbone (central line)
into a fine tube inserted into a vein in the crook of your arm (PICC line).
Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you'll be given an anti-sickness (anti-emetic) drug. The drug can be given by injection through the cannula, central line or PICC line, or may be taken as tablets.
The steroid and chemotherapy drugs are then given separately.
How often treatment is given
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Your doctor may use the word 'regimen' (eg the PMitCEBO regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the particular treatment you're receiving. PMitCEBO is usually planned over two weeks.
The drugs are usually given as follows:
Mitoxantrone (a blue fluid) is given as an injection or as a drip (infusion) into your cannula or line usually over one hour. Mitoxantrone is given on day one.
Cyclophosphamide (a colourless fluid) is given as an injection or infusion. This usually takes about 30 minutes. Cyclophosphamide is given on day one.
Etoposide (a colourless fluid) is given by infusion over about one hour. Etoposide is given on day one.
Prednisolone is a tablet usually taken once a day. You'll begin having prednisolone on day one. It's then taken every day for four weeks followed by every other day for eight weeks. You'll be given a supply of prednisolone to take home.
You'll then have no treatment (apart from taking the prednisolone tablets) for the next six days. After that you'll have:
Bleomycin (a colourless fluid) is given as an injection or infusion over about an hour. Bleomycin is given on day eight.
Vincristine (a colourless fluid) is given as an infusion usually over 10-15 minutes. Vincristine is given on day eight.
If you're having your treatment as a day patient you can go home in between days 1-8. The cannula will be removed before you go.
If you have a central or PICC line, it will usually stay in place ready for the next cycle of your chemotherapy. You'll be shown how to look after the line.
You'll also be given a supply of anti-sickness tablets to take home with you, as well as a course of antibiotic tablets to help prevent infection.
It is important to take all the tablets as prescribed by your doctor.
This completes one cycle of PMitCEBO. Each cycle takes two weeks. Usually 4-8 cycles are given over a period of 2-4 months. This makes up a course of chemotherapy.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone who has PMitCEBO chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
PMitCEBO can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins around 10-14 days after treatment. The level of your white blood cells will vary throughout treatment. Your doctor or nurse will monitor this regularly using a blood test.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
You'll usually have the blood test before having more chemotherapy to check the number of white blood cells is at a safe level. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising or bleeding
PMitCEBO can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low
PMitCEBO can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 3-4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Sore mouth and ulcers
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections.
Your nails may become darker or ridged. They usually return to normal within a few months of finishing the treatment.
Some people have a strange taste in their mouth and at the back of their throat while they have the chemotherapy. This usually passes once the chemotherapy drip or injection has finished. It can help to suck some sweets while having the treatment.
You may also notice that food tastes different. Normal taste usually comes back after treatment finishes.
Numbness or tingling in the hands or feet
This is due to the effect of vincristine on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
Less common side effects
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Constipation or diarrhoea
PMitCEBO can cause constipation or diarrhoea. Constipation can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Diarrhoea can usually be easily controlled with medicine, but tell your doctor if it’s severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Your urine may become a blue-green colour. This may last for up to 24 hours after you’ve had your treatment. It's normal and is due to the colour of the mitoxantrone.
Leakage into the tissue around the vein (extravasation)
If this happens when PMitCEBO is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Mitoxantrone may cause a bluish discoloration along the vein. This is due to the colour of the drug and it will return to normal when the treatment finishes.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat. You might find our information about taking care in the sun useful.
Bleomycin can cause a rash, which may be itchy. You may also notice long streaks on your skin, as if you have been scratched. Your skin will go back to normal a few months after treatment finishes.
Sometimes, areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.
These can happen a few hours after you have bleomycin. If you have headaches or aching joints and muscles, it's important to drink plenty of fluids and rest. Contact your doctor if these symptoms continue as they can give you medicines to help reduce the effect. If the flu-like symptoms are particularly bad, it's possible to have an antihistamine injection before your next injection of bleomycin.
Treatment with PMitCEBO may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Changes in the way your heart works
This is a rare side effect of mitoxantrone. Tests to see how well your heart is working may be carried out before you start treatment. Tell your doctor if you experience shortness of breath, fatigue or leg swelling.
Appetite changes and weight gain
You may notice you feel hungrier than usual while taking steroids, and this can make you want to eat more. If you’re concerned about gaining weight, you can speak to your doctor, specialist nurse or dietitian. You might also like to read our information about managing your weight.
Raised blood sugar
Occasionally, prednisolone (a steroid) can cause your blood sugar level to rise. During treatment you’ll you may have regular blood tests to check this. Your urine may also be tested for sugar.
Tell your doctors know if you get very thirsty or if you’re passing more urine than usual. This can be a sign that your blood sugar level is rising.
Irritation of the stomach lining
Prednisolone can irritate the lining of the stomach and may cause a stomach ulcer or make one worse. You should take the tablets with a meal or a drink of milk to reduce this side effect. Tell your doctor if you have indigestion, or pain or discomfort in the tummy (abdomen). You may be prescribed medication to reduce irritation of the stomach.
Prednisolone may affect the salt and water balance in your body. You may notice that your ankles and/or fingers swell. Some people have a bloated feeling in the abdomen. Let your doctor know if this happens. This is usually only a problem with long-term steroid treatment.
Behavioural changes and mood swings
Occasionally, steroids can cause mood swings, difficulty sleeping and perhaps anxiety or irritability. Let your doctor know if there are any changes in your behaviour that are worrying you. Difficulty with sleeping may be helped by taking the steroids in the early part of the day, but discuss this with your doctor first.
The whites of your eyes may have a slight blue tint. This is very rare and is temporary. It is due to the colour of the mitoxantrone. Your eyes will return to normal when the treatment finishes.
Changes to the lungs
Bleomycin and cyclophosphamide can cause some changes to the lungs. This can happen during treatment or after it has finished. Your doctor can give you information about this potential side effect.
Tell your doctor if you smoke, or if you notice any wheezing, coughing or breathlessness. You’ll probably have a chest x-ray before starting bleomycin treatment and you may have regular chest x-rays during your treatment.
Hot flushes, dizziness, and the feeling of a blocked nose
This can happen while the cyclophosphamide is being given. If you have any of these symptoms, tell the doctor or nurse so they can slow the drip down.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it's important to tell your doctor straight away if you have any of these symptoms. Most clots can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or a chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child is likely to be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having this treatment as it may harm the developing baby. It's important to use effective contraception while taking this drug andfor at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
Because of the effect of chemotherapy on the ovaries, women may find that their periods become irregular and may eventually stop. In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms, such as hot flushes, sweats and vaginal dryness.
Things to remember about prednisolone tablets
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It’s important to take your tablets at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you're taking a course of chemotherapy tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in their original packaging, and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place and out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets/capsules to the pharmacist. Don't flush them down the toilet or throw them away.
If you're sick just after taking the tablets tell your doctor as you may need to take another dose. Don't take another tablet without telling your doctor first.
If you forget to take a tablet/capsule, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
This section is based upon our PMitCEBO chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 367h edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).