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This information is about a chemotherapy treatment for Hodgkin lymphoma (a type of cancer of the lymphatic system) called ABVD. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
ABVD is named after the initials of the chemotherapy drugs used, which are doxorubicin (pronounced docks-o-rou-bi-sin), which was originally called Adriamycin®), bleomycin (blee-o-my-sin), vinblastine (vin-blas-teen) and dacarbazine (de-car-ba-zeen).
ABVD chemotherapy is usually given to you as a day patient. Before you start treatment you will need to have a blood test on the same day, or a day or two beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
When you begin your treatment, the nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given an anti-sickness (anti-emetic) drug as tablets or by injection through the cannula, central line or PICC line, which is connected to a drip (infusion). The chemotherapy drugs are then given separately, which involves:
All of this may take up to two hours.
If you are having treatment as a day patient you can then go home. The cannula will be removed and you will be given a supply of anti-sickness tablets to take with you. It is important to take these as directed even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than at stopping it once it has started.
Your doctor may use the word 'regimen' (eg the ABVD regimen), when talking about your chemotherapy. This means the whole plan, or schedule, of the particular treatment that you are receiving.
When your treatment begins, you will be given doxorubicin, bleomycin, vinblastine and dacarbazine (as described) for one day only. After this you will have a rest period with no treatment for two weeks. The same treatment is then repeated on the 15th day, and after it you will have another rest period of two weeks. This four-week period completes what is called a cycle of your chemotherapy treatment.
On the 29th day the treatment is given again, which begins the next cycle of your chemotherapy treatment. Two to eight cycles of treatment may be given, over a period of two to eight months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone who is having ABVD chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but which are not listed below, please let your nurse or doctor know.
Lowered resistance to infection ABVD can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding ABVD can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having treatment with ABVD you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if this is a problem.
Feeling sick (nausea) and vomiting Your doctor can now prescribe very effective anti-sickness drugs to prevent or reduce nausea and vomiting. However, if the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs may cause constipation. Let your doctor or nurse know if this is a problem.
Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try and get as much rest as you need.
Hair loss This usually starts 3–4 weeks after the first cycle of treatment. Hair is usually lost completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will start to grow again once the treatment has finished.
Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you do have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.
Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.
Numbness or tingling in hands or feet This is due to the effect of vinblastine on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these side effects. This problem usually improves slowly a few months after treatment is over.
Pain at the injection site or along the vein This can happen while dacarbazine is being given. If you feel pain, tell the nurse giving you the chemotherapy. The pain can usually be alleviated and steps can be taken to avoid it happening again in the future.
Allergic reaction Some people can have an allergic reaction to dacarbazine or bleomycin. Signs of this can include skin rashes and itching, a high temperature, shivering, dizziness, headache and breathlessness. Let your nurse or doctor know if you have any of these symptoms. A reaction can be treated quickly.
Fevers and chills This may happen several hours after bleomycin is given, but does not usually last long. Your doctor may give you a steroid drug (hydrocortisone) beforehand to prevent this from happening.
Skin changes Rarely, your skin may darken. If it does, it usually goes back to normal a few months after treatment has finished. Bleomycin can cause a rash that may be itchy and your doctor can prescribe medicine to help with this.
During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes. Sometimes areas that have previously been treated with radiotherapy may become red and sore. Let your doctor know if this happens.
Changes in nails Your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.
Changes in the way your heart works This is very rare with usual doses of doxorubicin, but may occasionally happen when high doses are used. Tests to see how well your heart is working may be carried out before you start treatment.
Changes to the lungs Bleomycin may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue around the vein If this happens while doxorubicin or vinblastine are being given, the tissue in that area can be damaged. If you notice any stinging or burning around the vein while the drugs are being given, tell the doctor or nurse immediately.
Discoloured urine Doxorubicin is coloured red and, due to this, your urine may become a pink-red colour. This may last up to 24 hours after your treatment and is quite normal.
Fertility Your ability to conceive or father a child may be affected by this treatment. It is important to discuss this with your doctor before starting treatment. However, ABVD is less likely to affect fertility than some other chemotherapy treatments for Hodgkin lymphoma.
Contraception It is not advisable to become pregnant or to father a child while having this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.
Loss of periods in women You may find that your periods become irregular and may eventually stop because of the effect of chemotherapy on your ovaries. In younger women this may be temporary, but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our ABVD chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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