This page tells you about the chemotherapy drug combination PMitCEBO. There is information about
PMitCEBO is the name of a combination of chemotherapy drugs and a steroid. It is made up of the drugs
- P – Prednisolone, a steroid
- Mit – Mitoxantrone
- C – Cyclophosphamide
- E – Etoposide
- B – Bleomycin
- O – Vincristine (also called Oncovin)
It is a treatment for non Hodgkin lymphoma (NHL).
You have PMitCEBO chemotherapy as cycles of treatment. Each cycle of treatment lasts 2 weeks. Depending on your needs, you may have between 4 and 8 cycles, taking 2 to 4 months in total.
You have the drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
Prednisolone comes as white tablets in different doses. Your doctor will tell you the dose to take. You take the steroids every day until you finish your chemotherapy. It is very important that you take your tablets as prescribed after a meal, or with milk, as they can irritate your stomach. Your doctor will also prescribe a course of antibiotic tablets for you to take to help prevent infection.
You have each cycle of treatment in the following way
- On the first day you have drips (infusions) of cyclophosphamide, etoposide and mitoxantrone, taking about 2 hours and you begin taking prednisolone tablets each day
- A week later you have a drip of vincristine into a vein alongside a drip of salt water (saline) and a drip of bleomycin, which takes about 40 minutes
Although you carry on taking your prednisolone tablets, you have no chemotherapy drugs for the next 6 days. You then start another treatment cycle.
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.
We've listed the side effects associated with PMitCEBO below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.
You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
The side effects may be different if you are having PMitCEBO with other drugs.
Tell your doctor or nurse straight away if any of the side effects get severe.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – 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)
- Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year but for some people it may continue
- Feeling or being sick – this is usually well controlled with anti sickness medicines
- Complete hair loss affects most people but this is temporary and your hair will grow back when the treatment ends
- Loss of appetite
- Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons. This starts within a few days or weeks and usually goes within a few months of finishing treatment
- An allergic reaction affects up to 1 in 2 people (50%) having bleomycin – it may cause fever and chills while you have the drip and a high temperature the night afterwards. If you have this effect, tell your doctor or nurse when you go for your next treatment
- Skin reactions such as reddening, darkening or thickening of the skin or dry, peeling skin at the fingertips – these effects are most likely to begin 2 to 3 weeks after starting treatment
- Brittle, chipped and ridged nails
- A sore mouth or sores on the lips
- A metallic taste or taste changes
- A drop in blood pressure if you have etoposide too quickly – if you feel dizzy or faint, call your nurse straight away so they can slow your drip down
- Women may stop having periods (amenorrhoea) but this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
Between 1 and 10 in every 100 people have one or more of these.
- Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
- Inflammation of the lungs affects about 1 in 10 people (10%) and is more likely in people over 70. You will have lung tests before and during treatment. Tell your doctor or nurse if you develop a dry cough or shortness of breath (especially in cold weather)
- Inflammation of the bladder (cystitis) may cause pain and occasionally bleeding when you pass urine. Drink at least 2 pints of fluid a day and contact your doctor or nurse straight away if you see blood in your urine
- Skin may redden and get sore in areas where you have had radiotherapy – this is harmless and usually goes away on its own. Keep affected areas out of the sun
- Temporary liver changes that are very mild and unlikely to cause symptoms – they will almost certainly go back to normal when treatment is finished
- Inflammation around the drip site – tell your chemotherapy nurse straight away if you notice any signs of redness, swelling or leaking at your drip site
- Temporary lack of bladder control (incontinence) due to the effect of vincristine on bladder nerves
- Jaw pain – let your nurse know if you have this
- Vincristine can cause high temperatures (fevers) in children, starting 6 to 24 hours after treatment and lasting for 2 or 3 days – tell your doctor or nurse straight away if you have a high temperature
- Constipation – let your treatment team know if you are constipated for more than 3 days
Fewer than 1 in 100 people have these effects.
- There is a small risk that you may get a second cancer some years after PMitCEBO treatment
- The whites of the eyes take on a blue tint for some people after mitoxantrone but this is temporary
The following side effects usually go back to normal within two months of finishing vincristine treatment. Tell your doctor or nurse if you have any of these side effects
- Muscle cramps
- Difficulty balancing when walking
- Bone pain
- Blurred or double vision
- Hearing loss or dizziness
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
These drugs may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Do not breastfeed during this treatment because the drug may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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