PMitCEBO

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) and some other cancer types. 

How it works

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

How you have it

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

You have prednisolone as tablets. 

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

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

When you have it

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

Day 1
  • You have cyclophosphamide, etoposide and mitoxantrone as separate drips (infusions) into a vein. This takes about about 2 hours.
  • You have prednisolone tablets.
Day 8
  • You have vincristine as a drip into a vein.
  • You have fluid (saline) as a drip into a vein.
  • You have bleomycin as a drip into a vein.

Although you carry on taking your prednisolone tablets, you have no chemotherapy drugs for the next 6 days. You then start another 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.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely 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. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

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. 

Breathlessness 

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

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).

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. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all 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 treating it once it has started.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg 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 weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. 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. 

Tenderness and swelling of the fingertips

Your fingertips might swell and become tender. This can make it difficult to doing things like buttoning up your shirt or blouse. Talk to your doctor or nurse if this happens. 

Skin changes

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

You might also have darkening of your skin, stretch marks and blisters.

Sore mouth

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

You could also get sores on your lips.

Constipation 

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Tummy (abdominal) pain

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 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.

High temperature (fever)

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

An allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. 

Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while and give you medicine to help relieve your symptoms.

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
  • hives
  • general swelling
  • dizziness
  • high blood pressure - tell your doctor if you are having headaches
  • an inflamed and sore food pipe (oesophagus)
  • inflammation of the blood vessels
  • a high temperature with a drop in white blood cells
  • changes to the way your heart works and an increased risk of heart failure
  • leukaemia or another cancer - you might develop a second cancer years after this treatment
  • nerve changes including tenderness and pain
  • changes to eyesight including blurred vision
  • depressed, irritable, moody and suicidal thoughts
  • confusion and anxiety
  • hallucinations and delusion
  • periods of great excitement and high activity (mania)
  • changes to sleep
  • stomach ulcer
  • increase in body hair
  • schizophrenia becoming worse if you are or have been schizophrenic

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:

  • inflammation of the pancreas
  • bleeding from your stomach, intestines and bowel
  • taste changes
  • red, sore, itchy eyes (conjunctivitis)
  • not having enough fluid in the body (dehydration)
  • loss of hearing
  • changes to how much urine you pass - can be an increased, reduced or not being able to pass any urine
  • 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

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:

  • a rounded face (moon face)
  • increase appetite and weight gain
  • epilepsy getting worse if you have epilepsy
  • cataracts
  • acne
  • impaired healing
  • bone weakness (osteoporosis) and increased risk of bone fractures
  • a blood clot in the deep veins of your body (deep vein thrombosis, DVT) that could possibly travel to your lungs (pulmonary embolism). This could be life threatening if not treated quickly

Symptoms of a blood clot includes:

  • pain, redness and swelling around the area where the clot is and may feel warm to touch
  • breathlessness
  • pain in your chest or upper back – dial 999 if you have chest pain
  • coughing up blood
Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot.

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 father a child 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 father a child while you are having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.

Women must not become pregnant for at least a year after the end of treatment. Men should not father a child for at least 6 months after treatment. 

Breastfeeding

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

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

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 the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

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.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. 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 go to the electronic Medicines Compendium (eMC) website.

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

Related links