PMitCEBO is named after the initials of the drugs used:
You have PMitCEBO in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a blood specialist (haematologist), a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or a person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. They give you the chemotherapy through one of the following:
- a short thin tube that the nurse puts into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a nearby vein (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
You take prednisolone as tablets. Some of the chemotherapy drugs are given as an injection with a drip (infusion) of fluids to flush it through. Some are given as an infusion. Your nurse will usually run any infusions through a pump, which gives you the treatment over a set time.
When the chemotherapy is being given
Some people might have the following side effects while they are having the chemotherapy:
Flushes and blocked nose
Some people have hot flushes, a feeling of having a blocked nose and a strange taste. This doesn’t last long. Tell your nurse if you have these symptoms.
Rarely, chemotherapy may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include:
- a rash
- feeling itchy, flushed or short of breath
- swelling of your face or lips
- feeling dizzy
- having pain in your tummy, back or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having vincristine or mitoxantrone, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is rare, but it’s important that it’s dealt with quickly if it happens.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Bleomycin may cause flu-like symptoms such as feeling hot or cold, feeling shivery, having a headache, and aching. You may have these symptoms while the drug is being given or several hours after. Your nurse will tell you if this is likely to happen. They may advise you to take paracetamol. Drinking plenty of fluids will also help.
If the symptoms are severe or don’t improve after 24 hours, contact the hospital.
Your course of PMitCEBO
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of PMitCEBO lasts 14 days (two weeks).
On day 1 of the cycle, your nurse will give you:
- mitoxantrone (a blue liquid) as an injection with a drip (infusion) of fluids to flush it through, or as an infusion over 10–15 minutes
- cyclophosphamide (a colourless fluid) as an injection into a vein, or as an infusion over 30 minutes
- etoposide (a colourless fluid) as an infusion over 1–2 hours.
They will also give you prednisolone tablets to take every day for 14 days (days 1–14 of the cycle).
On day 8 of the cycle, your nurse will give you:
- vincristine (a colourless fluid) as an infusion over 5–10 minutes
- bleomycin (a colourless fluid) as an infusion over about 60 minutes.
At the end of the 14 days, you start your second cycle of PMitCEBO. This is exactly the same as the first.
At the beginning of the third cycle of treatment (day 29), you start taking the prednisolone tablets every other day (on alternate days). You keep taking prednisolone like this until your course of PMitCEBO is complete.
You will have up to eight cycles of PMitCEBO over 16 weeks. Your doctor or nurse will tell you the exact number of cycles that you are likely to have.
You can usually go home after your chemotherapy has been given. If you had treatment through a cannula, it will be taken out before you go home. If you have a central or PICC line, it will stay in place ready for the next cycle of your chemotherapy. Your nurse or doctor will show you how to look after the line.
Before you go home, the nurse or pharmacist will give you prednisolone tablets and drugs to help prevent side effects such as sickness and infection. Take all your tablets exactly as explained.
If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Other things to remember about your tablets:
- Keep them in the original package at room temperature and away from heat and direct sunlight.
- Keep them safe and out of the reach of children.
- If your treatment is stopped, return any remaining tablets to the pharmacist.
Possible side effects of PMitCEBO Back to top
We explain the most common side effects of PMitCEBO here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of them.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects which, rarely, may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice at any time of the day or night. Save these numbers in your mobile phone or keep them somewhere safe.
More information about these drugs
We are unable to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
PMitCEBO can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia. Your doctor may prescribe you antibiotics to help prevent an infection.
Contact the hospital straight away on the number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cell numbers are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
PMitCEBO can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. If you feel like this, tell your doctor or nurse. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It is easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Vincristine may make you constipated and cause tummy pain. Drinking at least two litres (three and a half pints) of fluids every day will help. Try to eat more foods that contain fibre such as fruit, vegetables and wholemeal bread. Also try to take some regular gentle exercise.
If you haven’t had a bowel motion for two days, contact the hospital for advice. Your doctor can prescribe laxatives to help you. If you are constipated and have tummy pain or are being sick, always contact the hospital straight away.
Tummy pain and/or indigestion
Steroids can irritate the stomach lining. If you have pain in your tummy or indigestion, let your nurse or doctor know. They can prescribe drugs to help reduce stomach irritation.
Take your steroid tablets with food to help protect your stomach.
Steroids can make you feel much hungrier than usual and you may gain weight. Your appetite will go back to normal when you stop taking them. If you’re worried about gaining weight, talk to your doctor or nurse.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures in the morning, at night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse may ask you to rinse your mouth regularly or use mouthwashes. It is important to follow any advice you are given and to drink plenty of fluids.
If you have any problems with your mouth, tell your nurse or doctor. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
You may also notice that food tastes different. Normal taste usually comes back after treatment finishes.
Feeling very tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day.
Your skin may darken during treatment. Occasionally, bleomycin causes scratch-like streaks to appear on of the skin. If you’ve had radiotherapy (either recently or in the past), the area that was treated may become red or sore.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but you need to use a sun cream with a sun protection factor (SPF) of at least 30. You should also cover up with clothing and a hat.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Your nails may become brittle and break easily. They may get darker or discoloured or you may get lines or ridges on them. These changes grow out after treatment finishes. During treatment, wear gloves when washing dishes or using detergents to protect your nails.
Mood and behaviour changes
Steroids can affect your mood. You may feel anxious or restless, and have mood swings or problems sleeping. Taking your steroids in the morning may help you sleep better at night.
If you have any of these side effects, tell your doctor or nurse. They may make some changes to your treatment if the side effects become a problem.
Numb or tingling hands or feet
This is caused by the effect of vincristine on nerves. It is called peripheral neuropathy. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but, in some people, they may never go away. Talk to your doctor if you are worried about this.
Mitoxantrone may cause the whites of your eyes to have a slight blue tint. This goes away when treatment finishes.
Your urine may be a blue-green colour for up to 48 hours after you’ve had your treatment. This is due to the colour of mitoxantrone.
Cyclophosphamide may irritate your bladder and cause discomfort when you pass urine. Drink plenty of fluids – at least two litres (three and a half pints) during the 24 hours following chemotherapy. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.
If you feel any discomfort or stinging when you pass urine or if you notice any blood in it, contact the hospital straight away.
Raised levels of uric acid in the blood
PMitCEBO may cause the lymphoma cells to break down quickly. This releases uric acid (a waste product) into the blood. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you tablets called allopurinol (Zyloric ®) to help prevent this. Drinking at least two litres (three and a half pints) of fluids a day will also help. You will have regular blood tests to check the uric acid levels.
Build-up of fluid
You may put on weight or your ankles and legs may swell because of fluid building up. This is caused by steroids and is more common if you are taking them for a long time. Tell your doctor or nurse if fluid builds up. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling gets better after your treatment ends.
Raised blood sugar levels
Steroids can raise your blood sugar levels. Your nurse will check your blood regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include feeling thirsty, needing to pass urine more often and feeling tired. If you have these symptoms, tell your doctor or nurse.
If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will advise you how to manage this. You may need to adjust your insulin or tablet dose.
Changes in the way the liver works
PMitCEBO can cause changes in the way your liver works. It will usually go back to normal after treatment finishes. You will have regular blood tests to check how well your liver is working.
Less common side effects of PMitCEBO Back to top
Changes to the lungs
Bleomycin can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough,or a fever or if you feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange tests to check your lungs.
Changes to the heart
Mitoxantrone can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless, or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.
PMitCEBO can increase the risk of developing a second cancer, usually leukaemia, years later. But this is rare and the benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.
It is important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about PMitCEBO Back to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can further increase this risk. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. If you have any of these symptoms, contact your doctor straight away. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
PMitCEBO may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It is important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary but, for others, it is permanent and they start the menopause.
Women are advised not to breastfeed during, and for a few months after, chemotherapy treatment. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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