PMitCEBO is named after the initials of the drugs used:
- P – prednisolone, a steroid
- Mit – mitoxantrone
- C – cyclophosphamide
- E – etoposide
- B – bleomycin
- O – vincristine (Oncovin®)]
PMitCEBO is used to treat non-Hodgkin lymphoma (NHL). It may sometimes be used to treat other cancers. It is best to read this information with our general information about chemotherapy and the type of cancer you have.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You will be given PMitCEBO in the chemotherapy day unit or during a stay in hospital. A chemotherapy nurse will give it to you.
During treatment you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist. This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have chemotherapy.
You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse usually gives you anti-sickness (anti-emetic) drugs before the chemotherapy. The chemotherapy drugs can be given through:
- a short thin tube 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 vein close by (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.
Your course of chemotherapy
You usually have a course of several cycles of treatment over a few months. Your nurse or doctor will discuss your treatment plan with you. Each cycle of PMitCEBO takes 2 weeks.
On day 1, your nurse will give you:
- mitoxantrone (a blue liquid) as a drip or as a slow injection (bolus) into a vein
- cyclophosphamide as a slow injection into a vein (bolus) or as a drip
- etoposide as a drip
- prednisolone tablets to take every day for 14 days. Take these exactly as your nurse has explained.
On day 8, your nurse will give you:
- vincristine as a drip
- bleomycin as a slow injection into a vein or as a drip.
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 cycle 3, you take the prednisolone tablets every other day. You keep taking your prednisolone like this until your course of PMitCEBO is complete.
You will have up to 8 cycles of PMitCEBO over 16 weeks. Your doctor or nurse will tell you the exact number of cycles you are likely to have.
We explain the most common side effects of this treatment here. We also include some less common side effects. You may get some of the side effects we mention, but you are unlikely to get all of them.
You may also have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) to download a Patient Information Leaflet (PIL) for these drugs. The leaflet lists all known side effects.
Some people have an allergic reaction while having this treatment.
Signs of a reaction can include:
- feeling hot or flushed
- a skin rash
- feeling dizzy
- a headache
- feeling breathless
- swelling of your face or mouth
- pain in your back, tummy or chest.
Your nurse will check you for signs of a reaction during your treatment. If you feel unwell or have any of these signs, tell them straight away. If you do have a reaction, it can be treated quickly.
Sometimes a reaction can happen up to 24 hours after treatment. If you get any signs or feel unwell after you get home, contact the hospital straight away.
The drug leaks outside the vein
If the drug leaks outside the vein, it can damage the surrounding tissue. This is called extravasation. Extravasation is not common but if it happens it is important to treat it quickly. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the contact telephone number they gave you.
Pain along the vein
Bleomycin can cause pain at the place where the drip (infusion) is given or along the vein. If you feel pain, tell your nurse or doctor straight away so that they can check the site. They may give the drug more slowly or flush it through with more fluid to reduce pain.
This treatment may cause flu-like symptoms such as:
- feeling hot or cold and/or shivery
- having a headache
If you have this, tell your nurse or doctor straight away. You may have these symptoms while the drug is being given or several hours afterwards. 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. Your nurse may give you a drug before your chemotherapy, to reduce the risk of flu-like symptoms occurring.
If the symptoms are severe or do not improve within 24 hours, contact the hospital.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is called neutropenia.
Your doctor may give you antibiotics and other drugs to try to stop you getting an infection. These are called prophylactic medicines.
If you have an infection, it is important to treat it as soon as possible. Contact the hospital straight away on the 24-hour contact number you have if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection.
Symptoms of an infection include:
- feeling shivery
- a sore throat
- a cough
- needing to pass urine often.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment 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 that you cannot explain. This includes:
- bleeding gums
- tiny red or purple spots on the skin that may look like a rash.
Some people may need a drip to give them extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment 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. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
You may feel sick during this treatment. Your doctor will give you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.
If you feel sick, take small sips of fluids and eat small amounts often. If you continue to feel sick, or if you vomit more than once in 24 hours, contact the hospital straight away. They will give you advice and may change the anti-sickness drug to one that works better for you.
This treatment can cause constipation. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
If you have diarrhoea, tell your nurse. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.
Tummy pain or indigestion
Steroids can irritate the stomach lining. Tell your doctor or nurse if you have pain in your tummy (abdomen) or indigestion. They can give you drugs to help reduce stomach irritation. Take your tablets with food to help protect your stomach.
Steroids can make you feel more hungry than usual and you may gain weight. Your appetite will go back to normal when you stop taking them. If you are worried about gaining weight, talk to your doctor or nurse.
You may get a sore mouth or mouth ulcers. This can make you more likely to get a mouth infection.
Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
Feeling tired is a common side effect. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy. If you feel sleepy, do not drive or operate machinery.
Your hair will get thinner or you may lose all the hair from your head. You may also lose your eyelashes, eyebrows or other body hair. Hair loss usually starts after your first or second treatment.
Your nurse can talk to you about ways to cope with hair loss. There are ways to cover up hair loss if you want to. It is important to cover your head to protect your scalp when you are out in the sun.
Hair loss is almost always temporary and your hair will usually grow back after treatment ends.
This treatment may cause hearing changes, including hearing loss. You may have ringing in the ears. This is called tinnitus. You may also become unable to hear some high-pitched sounds. Hearing changes usually get better after this treatment ends. But some can be permanent. Tell your doctor if you notice any changes in your hearing.
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. Etoposide can cause a rash which may be itchy. It is rare that skin rashes become severe. If you have pain in your skin and a blister like rash, contact the hospital straight away.
Your skin may darken in patches during treatment. Occasionally, bleomycin can cause long thin streaks that look a bit like scratches. These may appear on one or more areas of skin. If you have 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 will be more sensitive to the sun and your skin may burn more easily. 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 grow more slowly or break more easily. You may notice white lines across your nails, or other changes to their shape or colour. Once the treatment has ended, any changes usually take a few months to grow out.
There are things you can do to look after your nails:
- Keep your nails and hands moisturised.
- Wear gloves to protect your nails when you are doing things in the house or garden.
- Do not use false nails during chemotherapy. It is fine to wear nail varnish.
- If your toenails are affected, wear well-fitted shoes to cushion them.
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. It is best not to drive or operate machinery if you feel like this.
Vincristine may cause pain in your jaw. Tell your nurse or doctor if you notice this.
Muscle or joint pain
You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor so they can give you painkillers. Tell them if the pain does not get better. Having warm baths and taking regular rests may help.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. 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 for some people they may never go away. Talk to your doctor if you are worried about this.
The whites of your eyes may have a blue tint while you are having mitoxantrone. This goes away when treatment finishes.
Blue or green pee (urine)
Mitoxantrone may turn your pee a blue or green colour after you have had your treatment. This may last for 1 to 2 days. It is not harmful.
Cyclophosphamide may irritate your bladder and cause discomfort when you pee (pass urine). Make sure you drink plenty of fluids during the 24 hours following chemotherapy. Try to drink at least 2 litres (3½ pints).
It is also important to empty your bladder regularly and try to pass urine as soon as you feel the need to go.
Contact the hospital straight away if:
- you feel any discomfort or stinging when you pass urine
- if you notice any blood in your urine
- you are having problems passing urine.
Raised levels of uric acid in the blood (tumour lysis syndrome)
This treatment may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. The kidneys usually get rid of uric acid but may not be able cope with large amounts. Too much uric acid can cause swelling and pain in the joints (gout).
Your doctor may give you drugs to help prevent this. Drinking at least 2 litres (3½ pints) of fluid 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. This is because of fluid building up. It is caused by steroids and is more common if you are taking them for a long time. Tell your doctor or nurse if this happens. If your ankles and legs swell, it can help to put your legs up on a foot stool or cushion. The swelling will go down after your treatment ends.
Raised blood sugar levels
Steroids can raise your blood sugar levels. Your nurse will check your blood sugar regularly for this. They may also test your urine for sugar. Symptoms of raised blood sugar include:
- feeling thirsty
- needing to pass urine often
- feeling tired.
Tell your doctor or nurse if you have these symptoms.
If you have diabetes, your blood sugar levels may be higher than usual. Your doctor will talk to you about how to manage this. You may need to adjust your insulin or tablet dose.
Effects on the kidneys and livers
PMitCEBO can affect how your kidneys and liver work. This will usually go back to normal after treatment ends. You will have regular blood tests to check how well your kidneys and liver are working.
Effects on the heart
Chemotherapy can affect the way the heart works. You may have tests to see how well your heart is working. These may be done before, during and sometimes after treatment. If the treatment is causing heart problems, your doctor can change the type of chemotherapy you are having.
Contact a doctor straight away if you:
- have pain or tightness in your chest
- feel breathless or dizzy
- feel your heart is beating too fast or too slowly.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor.
Effects on the lungs
You may have tests to check your lungs before, during and after treatment. Tell your doctor if you develop:
- a cough
You should also tell them if any existing breathing problems get worse.
Smoking can increase the risk of your lungs being affected. If you smoke talk to your doctor about stopping before you start treatment.
After treatment with bleomycin, breathing higher doses of oxygen for several hours can cause lung problems. If you need to have a general anaesthetic or oxygen therapy in the future, always tell the doctor that you have had bleomycin.
Effects on the lungs can happen months or years after treatment with bleomycin. Tell your doctor if you notice any changes. Scuba diving is not recommended after treatment with bleomycin.
Effects on the nervous system
Vincristine can affect the nervous system. If you feel dizzy or unsteady, it’s important to tell your doctor or nurse straight away. They may make some changes to your treatment. It is important not to drive or operate machinery if you notice these effects. Rarely, this treatment can cause fits (seizures).
This treatment can increase the risk of developing a second cancer years later. This is rare. The benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- pain, redness or swelling in a leg or arm
- chest pain.
If you have any of these symptoms, contact a doctor straight away.
A blood clot is serious, but can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Food and alcohol
During treatment with cyclophosphamide you should avoid grapefruit and grapefruit juice. This is because it can make cyclophosphamide less effective and may increase side effects.
Drinking alcohol during treatment with cyclophosphamide can increase the risk of feeling and being sick.
When taking prednisolone, you should avoid having liquorice as this can increase how much medicine is in your body.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Your doctor or nurse may talk to you about vaccinations. These help reduce your risk of getting infections.
Doctors usually recommend that you have a flu jab, which is an inactivated vaccination. People with weak immune systems can have this type of vaccination.
If your immune system is weak, you need to avoid live vaccinations such as shingles. Your cancer doctor or GP can tell you more about live vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while having this treatment. The drugs may harm a developing baby. It is important to use contraception during your treatment and for a while after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
Women are advised not to breastfeed while having this treatment. This is because the drugs could be passed to the baby through breast milk.
Some cancer drugs can affect whether you can get pregnant or make someone pregnant.
If you are a woman, your periods may become irregular or stop. This may be temporary, but for some women it is permanent. Your menopause may start sooner than it would have done.
If you have sex during this course of chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.