PMitCEBO chemotherapy

PMitCEBO is a combination treatment used to treat non-Hodgkin lymphoma. It may also 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.

PMitCEBO is usually given into a vein. You may have it as an outpatient or during a hospital stay. Your cancer doctor or nurse will tell you how often you will have it.

PMitCEBO can cause side effects. Some of the side effects can be serious, so it is important to read the detailed information below.

Your healthcare team can give you advice on how to manage any side effects. Tell your doctor or nurse straight away if you:

  • have a high temperature
  • feel unwell
  • have severe side effects, including any we do not mention here.

Rarely, side effects may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.

If you need medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is PMitCEBO?

PMitCEBO is named after the initials of the drugs used:

PMitCEBO is used to treat non-Hodgkin lymphoma. It is best to read this information with our general information about chemotherapy and the type of cancer you have.


How PMitCEBO is given

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. This is who we mean when we mention doctor or nurse 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. Some of the other drugs are given as an injection into a vein 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.

Your course of chemotherapy

You usually have a course of several 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 a drip
  • cyclophosphamide (a colourless fluid) as an injection into a vein, or as a drip
  • etoposide (a colourless fluid) as a drip.

They will also give you prednisolone tablets to take every day for 14 days (days 1 to 14 of the cycle).

On day 8 of the cycle, your nurse will give you:

  • vincristine (a colourless fluid) as a drip
  • bleomycin (a colourless fluid) as an injection 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 the third cycle of treatment (day 29), you start taking the prednisolone tablets every other day. You keep taking 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 that you are likely to have.

Going home

Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take these tablets and the prednisolone exactly as they have been explained to you.


About side effects

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 haven’t 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.

More information

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.


Side effects during treatment

Some people may have side effects while they are being given the chemotherapy or shortly after they have it:

Allergic reaction

Some people have an allergic reaction while having this treatment. Signs of a reaction can include:

  • feeling hot or flushed 
  • a skin rash
  • itching
  • shivering
  • 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 a few 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 this happens it can damage the tissue around the vein. This is called extravasation. Extravasation is not common but if it happens, it is important that it is dealt with 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 number they gave you.

Pain along the vein

Bleomycin can cause pain at the place where the injection 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.

Flu-like symptoms

Bleomycin may cause flu-like symptoms, such as:

  • feeling hot or cold and/or shivery
  • a headache
  • 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 fluid will also help.

If the symptoms are severe or don’t improve after 24 hours, contact the hospital.


Common side effects

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 (99.5F)
  • 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
  • diarrhoea
  • 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 chemotherapy. If your white blood cell count is 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 or nurse if you have any bruising or bleeding that you can’t explain. This includes:

  • nosebleeds
  • 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)

Chemotherapy 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.

Feeling sick

You may feel sick in the first few days after chemotherapy. 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 as soon as possible. They will give you advice and may change the anti-sickness drug to one that works better for you.

Constipation

This treatment can cause constipation. Here are some tips that may help:

  • Drink at least two litres (three and a half 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.

Tummy pain or indigestion

Steroids can irritate the stomach lining. Let your nurse or doctor know if you have pain in your tummy or indigestion. They can give you drugs to help reduce stomach irritation. Take your steroids with food to help protect your stomach.

Increased appetite

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.

Sore mouth

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 bad 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

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.

Hair loss

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.

Skin changes

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 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'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.

Nail changes

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.
  • Don’t use false nails during this treatment. 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
  • have mood swings
  • have problems sleeping.

Taking your steroids in the morning may help you sleep better at night.

Tell your doctor or nurse if you have any of these side effects. They may make some changes to your treatment if the side effects become a problem.

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 or delay treatment for a short time. 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.

Eye changes

Mitoxantrone may cause the whites of your eyes to have a slight blue tint. This goes away when treatment finishes.

Discoloured urine

Your urine may be a blue-green colour for up to 24 hours after you have had your treatment. This is due to the colour of mitoxantrone.

Bladder irritation

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 chemotherapy and in the 24 hours after having it. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.

Tell your nurse or doctor straight away if you feel any discomfort or stinging when you pass urine or if you notice any blood in it.

Raised levels of uric acid (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 to cope with large amounts. Too much uric acid can cause swelling and pain in the joints, which is called gout.
Your doctor may give you allopurinol tablets to help prevent this. Drinking at least two litres (three and a half 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 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 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.

We have more information about diabetes and cancer.

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

Effects on the lungs

You may have tests to check your lungs before and during treatment. Tell your doctor if you develop:

  • a cough
  • wheezing
  • a fever (high temperature)
  • breathlessness

You should also tell them if any existing breathing problems get worse.

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.

Scuba diving is not recommended after treatment with bleomycin.

Effects on the heart

This treatment 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 treatment 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.

Second cancer

PMitCEBO 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.


Other information

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
  • breathlessness
  • 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.

Other medicines

Some medicines can affect chemotherapy or be harmful when you are having it. This includes medicines you can buy in a shop or chemist. Tell your cancer doctor about any drugs you are taking, including vitamins, herbal drugs and complementary therapies.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Fertility

Some chemotherapy drugs can affect whether you can get pregnant or father a child.

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.

There may be ways to preserve fertility for men and women. If you are worried about fertility, it is important to talk with your doctor before you start chemotherapy treatment.

Sex

If you have sex in the first few weeks after chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.

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.