PMitCEBO

PMITCEBO is the name of a combination of chemotherapy drugs used to treat non Hodgkin’s lymphoma (NHL). It is made up of the drugs

• P = Prednisolone, a steroid
• MIT = Mitoxantrone
• C = Cyclophosphamide
• E = Etoposide
• B = Bleomycin
• O = Vincristine also called Oncovin

The links above take you to more information about the individual side effects of each drug.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each effect or may change the severity. The side effects associated with PMITCEBO are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

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 all the chemotherapy 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 just before your course of treatment starts and it stays in place as long as you need it. Mitoxantrone is a blue coloured liquid. Cyclophosphamide, vincristine, bleomycin and etoposide are clear, colourless liquids.

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. You need to 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 (day 8) 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 from day 9 until day 14. You then start another treatment cycle.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick 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 in fingers and toes affects some people having vincristine and 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
• Vincristine can also cause a general feeling of weakness for some people – it usually goes back to normal a few weeks after the end of treatment but for some people may continue
• An allergic reaction affects up to 1 in 2 people (50%) having bleomycin – it may cause fever and chills during the infusion and a high temperature the night after. If you have this, 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 may occur – 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 – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• These drugs may have a harmful effect on a developing baby so do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

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%) treated with bleomycin and is more likely in people over 70 – you will have lung tests before and during treatment and should tell your doctor or nurse if you develop a dry cough or shortness of breath (especially in cold weather)
• Inflammation of the bladder (cystitis) can occur with cyclophosphamide and 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 but keep affected areas of skin out of the sun
• Temporary liver changes due to mitoxantrone – you will have blood tests to see how well your liver is working
• Inflammation around the drip site – tell your chemotherapy nurse immediately 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 caused by vincristine affecting your nerves
• Vincristine can cause fevers in children, starting 6 to 24 hours after treatment and lasting for 2 or 3 days – tell your doctor immediately 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.

• 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
• Staggering
• Bone pain
• Blurred or double vision
• Hearing loss or dizziness
• Confusion
• Depression
• Hallucinations

Not everyone will get these side effects. You may have 1 or 2 or several. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. You should have a contact number for your chemotherapy nurse, clinic or ward nurse. You can ring them if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.