PMitCEBO

PMitCEBO is the name of a cancer drug combination. It's a treatment for non-Hodgkin lymphoma (NHL).

It includes the drugs we list below, next to each drug we have how you pronounce the drug names in brackets:  

• P – prednisolone (pred-ni-so-lone) a steroid
• Mit – mitoxantrone (my-toe-zan-trone)
• C – cyclophosphamide (sye-cloh-foss-fah-mide)
• E – etoposide (ee-top-o-side)
• B – bleomycin (blee-oh-my-sin)
• O – vincristine (also called Oncovin) (vin-kris-teen)

How does PMitCEBO work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have PMitCEBO?

You have mitoxantrone, cyclophosphamide, etoposide, bleomycin and vincristine as a drip into a vein (infusion).

You take prednisolone as tablets. 

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Taking your tablets

You should take prednisolone tablets after a meal as they can irritate your stomach. Taking them in the morning might help to stop difficulty in sleeping (insomnia).

Talk to your specialist or advice line before you stop taking a cancer drug.

How often do you have PMitCEBO?

You have PMitCEBO as cycles of treatment. A cycle of treatment is the time between the start of one round of treatment and the start of the next round.

Each cycle of treatment is 2 weeks. You might have 4 to 8 cycles of treatment.

You usually have cycle 1 and cycle 2 as follows:

You then start your next treatment cycle.

You usually have cycle 3 onwards as follows:

You then start your next treatment cycle.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You might have a heart function test. This is because mitoxantrone can affect the way your heart works. You usually have the heart test before you start your treatment and regularly throughout.

What are the side effects of PMitCEBO?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Difficulty breathing

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Or you might develop a cough or breathing problems due to an infection, such as pneumonia or inflammation of the lungs (pneumonitis).

Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

You might notice more severe bruising or bleeding in other parts of your body. Or you might have dark red or black poo, or see blood in your vomit, but this is rare.

You must contact your hospital advice line straight away if you have any unusual bleeding.

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Loss of appetite and changes in your weight

You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Less commonly your weight might fluctuate, this means you may lose and gain weight while having this treatment. 

Skin changes

You may have some skin problems with this treatment. This can include:

• a rash
• dry and itchy skin
• changes in the colour of your nails and skin, this can also affect the palms of your hands and heels of your feet 
• oily spots on your face and back and chest (acne)
• blisters

Rarely you might have a condition where your skin becomes red in areas treated with radiotherapy. Or you may develop a severe skin reaction where your skin may become very painful and red, and your skin may peel. This can be life threatening. You might also feel feverish, and your eyes may be more sensitive to light. 

Call your healthcare team straight away if you notice any of these symptoms.

Sore mouth and throat

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

You might also have inflammation in the lining of your food pipe (oesophagus). And the corners of your mouth might become cracked and sore, but this is not very common.

Constipation 

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Tummy (abdominal) pain

You might have tummy pain or tummy cramps or feel bloated. Tell your treatment team if you have this, they can check the cause and give you medicine to help. 

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They can sometimes be severe, but this is rare. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

An allergic reaction

An allergic reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face, or throat, breathing difficulties, fever and chills. Some people may also have fits (seizures) but this is rare. Your nurse will give you medicines beforehand to try to prevent a reaction. 

Rarely these reactions can be life threatening.

Inflammation of the bladder

Inflammation of the bladder (cystitis) can cause pain and occasionally blood when passing urine. 

Depending on the dose of cyclophosphamide you have, you might have extra fluids through a drip to prevent bladder irritation. Or you might have a drug called mesna to protect your bladder.

Tell your healthcare team if you see blood in your wee or if you have pain passing urine.

Fingers and toes look pale and feel cold

This is due to poor blood flow to your fingers and toes. Tell your medical team if this is happening. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them:

• diarrhoea - be sure to drink plenty of fluids

• swelling, pain or soreness around the drip site - tell your nurse about this straight away if it happens

• feeling dizzy

• inflammation of the blood vessels

• changes in the way your heart works, including an increased risk of heart failure and a risk of a heart attack. Your heartbeat may feel faster or you might have high or low blood pressure

• leukaemia or another cancer - you might develop a second cancer years after this treatment

• headache

• feeling generally weak

• muscle weakness or muscle wasting, which might cause difficulty with walking

• problems with your speech

• bone weakness and increased risk of bone fractures

• changes in blood sugar levels

• slower wound healing

• a rounded face (moon face)

• tingling and numbness in your hands, arms, legs or feet

• eye problems including blurred vision, red, sore itchy eyes, and rapid eye movements. You may have changes to your vision, but this is rare

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• taste changes

• inflammation of the pancreas

• not having enough fluid in the body (dehydration)

• pain where the cancer is

• tumour lysis syndrome - an imbalance of chemicals circulating in your blood that can upset your heart rhythm and the way your kidneys work

• irregular or no periods-sometimes your periods might not start again until your treatment has finished

• difficulty swallowing

• feeling drowsy

• feeling depressed and irritable

• periods of great excitement and high activity (mania)

• confusion and anxiety

• your kidneys may not work as well as they should. They may not be able clear the toxins in your blood or become blocked. Symptoms include having a wee more often or less often, not being able to wee at all, and having loose stools (diarrhoea) with blood

Other side effects

The following side effects have also been reported. But it's not clear how often they happen. You might have one or more of them. They include:

• ringing in the ears or loss of hearing - this might be permanent for some people

• inflammation of the lining of the large bowel (colitis)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment. Women must not become pregnant for at least a year after the end of treatment. Men should not get someone pregnant for at least 6 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.