This information is about a chemotherapy treatment for Hodgkin lymphoma called ABVD.
The drugs that are used
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ABVD is named after the initials of the chemotherapy drugs used, which are:
How treatment is given
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ABVD chemotherapy is usually given to you as a day patient. Before you start treatment you'll need to have a blood test – either on the same day, or a day or two beforehand. You'll 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.
ABVD may be given in one of the following ways:
as an injection or as a drip (infusion)through a fine tube (cannula) inserted into a vein (intravenously), usually in the back of your hand
through a fine, plastic tube inserted under the skin and into a vein near your collarbone (central line)
into a fine tube inserted into a vein in the crook of your arm (PICC line).
You'll 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:
an injection of doxorubicin (a red fluid), given with an infusion of salt water (saline) into your cannula or line
an infusion of vinblastine (a colourless fluid).
bleomycin and dacarbazine (colourless fluids) are usually given as infusions but they can sometimes be given as slow injections into a fast-running, saline drip.
This may take a few hours. If you're having your treatment as a day patient, you can go home when it has finished; and the cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You'll be shown how to look after the line.
You'll be given a supply of anti-sickness tablets to take home with you. It's important to take these as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than at stopping it once it has started.
How often treatment is given
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Your doctor or nurse may use the word 'regimen' (eg the ABVD regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the particular treatment you're receiving.
On the first day of your treatment you'll be given doxorubicin, bleomycin, vinblastine and dacarbazine (as described) for one day only. After this you'll have a rest period with no chemotherapy for two weeks. The same treatment is then repeated on the 15th day, and after it you'll 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, and this begins the next cycle of your chemotherapy treatment. Between 2–8 cycles of treatment may be given, over a period of 2–8 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 here won't affect everyone having ABVD chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
ABVD can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment. Your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising or bleeding
ABVD can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
ABVD can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Anyone who has Hodgkin lymphoma should be given blood and platelet transfusions that have been treated with radiation (irradiated) indefinitely. This lowers the risk of the donated blood cells reacting against your own. Your hospital team should give you a card to carry or a Medicalert® to wear so hospital staff are aware in case of an emergency.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 3–4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
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 reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Your urine may become a pink-red colour. This may last up to 48 hours after you’ve had your treatment. It is normal and is due to the colour of the doxorubicin.
Less common side effects
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You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Numbness or tingling in the hands or feet
This is due to the effect vinblastine has on the nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms or have difficulty carrying out fiddly tasks, such as doing up buttons. This problem usually improves slowly a few months after the treatment has finished. Sometimes these symptoms can persist; tell your doctor if this happens.
Very rarely, other nerves may be affected, such as the neck nerves, which may cause pain in the jaw or double vision.
Leakage into the tissue around the vein (extravasation)
If this happens when doxorubicin or vinblastine is being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Some people receiving dacarbazine have an allergic reaction to the drug, either on the first dose or sometimes with further doses. Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety and a feeling that you want to pass urine. You'll be monitored for any signs of an allergic reaction while your treatment is being given. Tell your doctor or nurse about any side effects you have.
Fevers and chills
This may happen several hours after bleomycin is given but doesn't usually last long. Your doctor may give you a steroid drug (hydrocortisone) beforehand to reduce this effect.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF), and cover up with clothing and a hat.
Sometimes, areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.
Bleomycin can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this. Your skin may darken, due to overproduction of pigment. You may also notice long streaks on your skin, as if you have been scratched. Your skin will go back to normal a few months after treatment finishes
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 treatment ends.
Changes in the way your heart works
This is very rare with standard doses of doxorubicin but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given.
Changes to the lungs
Bleomycin can cause some changes to the lungs. This can happen during treatment or after it has finished. Your doctor can give you information about this potential side effect.
Tell your doctor if you smoke, or if you notice any wheezing, coughing or breathlessness. You’ll probably have a chest x-ray before starting bleomycin treatment and you may have regular chest x-rays during your treatment.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it's important to tell your doctor straight away if you have any of these symptoms. Most clots can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, may be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's 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.
It's not advisable to become pregnant or to father a child while having this treatment as it may harm the developing baby. It's important to use effective contraception while taking these drugs and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Loss of periods in women
You may find that your periods become irregular and may eventually stop due to the effect chemotherapy has on your ovaries. In younger women this may be temporary, but if you're closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This information is based upon our ABVD chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. September 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.