ABVD is the name of a chemotherapy regimen used in the treatment of Hodgkin’s lymphoma. It is perhaps the most common chemotherapy regimen used worldwide for newly diagnosed patients. It is a very effective combination of drugs for all stages of Hodgkin’s disease.
DRUGS USED IN ABVD REGIMEN
- Adriamycin (doxorubicin) – given as an infusion in your veins on days 1 and 15.
- Blenoxane (bleomycin) – given as a short intravenous injection on days 1 and 15.
- Velban (vinblastine) – given as a short intravenous injection on days 1 and 15.
- DTIC (dacarbazine) – given as an infusion in your veins on days 1 and 15.
HOW ABVD IS GIVEN?
You will be given ABVD in the chemotherapy day unit or during a short stay in the hospital. A chemotherapy nurse will give it to you.
During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse, and a specialist pharmacist.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that your blood cells are at a safe level to have chemotherapy.
You will see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. If your blood results are okay, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse usually gives you anti-sickness (antiemetic) drugs before the chemotherapy. The chemotherapy drugs can be given through:
- a short, thin tube the nurse puts into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you doxorubicin (a red fluid) as an injection directly into your vein with a drip (infusion) to flush it through. After this, you will have vinblastine as a drip over 5 to 10 minutes.
You will then have dacarbazine as a drip for at least 30 minutes. After this, you will have bleomycin either as a drip over about 30 minutes or as a slow injection into your vein, with a drip to flush it through.
HOW FREQUENTLY IS ABVD GIVEN?
ABVD is done in cycles. Each consists of giving the patient injections of these 4 drugs twice (on days 1 and 15). Cycles are repeated in 4-week intervals. That means that the second cycle starts 2 weeks after day 15 of the first cycle (on day 29), and so on. So the quick answer is that these cycles are repeated around every 28 days.
CYCLES OF ABVD
How many cycles are required depends on the stage of lymphoma and the presence or absence of certain prognostic factors — factors that give doctors an estimate of how likely treatments are to eliminate cancer cells. Early-stage disease with favorable risk factors may require only 2 to 4 cycles, whereas more advanced disease may require up to 8 cycles.
- Low blood counts – Your blood cell counts will be routinely monitored. Low white blood cell counts may result in deferring cycles, and the need for growth factors and protective measures from infection. Make sure to report a fever to your doctor immediately.
- Mouth sores – Mouth sores are very common, but changing your diet in certain ways can help significantly with this discomfort.
- Constipation – Your doctor may recommend medications to help prevent constipation.
- Discoloration of skin and nails
- Mild alteration of sensations in hands and feet – Peripheral neuropathy can be an annoying side effect and oncologists are looking at methods of possibly preventing this side effect.
- Nausea and vomiting – Nausea may be common, and ant-emetics (drugs that prevent and control nausea and vomiting) will be routinely prescribed. With preventive drugs, many people are surprised to find that nausea may be only minimal.
- Red urine – Adriamycin, called the “red devil” by some cancer patients, can result in red-appearing urine for a day or two following ABVD chemotherapy. This is not dangerous and is due to the color of the medication alone.
- Heartburn/acid reflux – Heartburn is a very common side effect of ABVD chemotherapy. Some doctors recommend medications such as Prilosec, Pepcid, or Nexium, but maybe be sure to talk to your oncologist ahead of time about what she recommends for you.
- Flu-like symptoms – DTIC may give you symptoms that feel like the flu, for example, muscle and body aches and chills.
- Hair loss
POSSIBLE LONG-TERM SIDE EFFECTS
When you’re in the midst of chemotherapy you don’t necessarily want to think about the long-term side effects of chemotherapy. After all, what’s important today is surviving cancer. Yet it’s important to be aware of some of these potential problems.
- Lung disease – Pulmonary toxicity (lung damage) from chemotherapy is a possible side effect of bleomycin, especially in older patients. Talk to your doctors about the symptoms you may expect, and what will happen if you develop this side effect.
- Heart disease – Adriamycin (doxorubicin) may damage the heart in some individuals. Your doctor will talk to you about tests to check your heart before treatment, as well as symptoms of this side effect.
- Infertility – Treatments for Hodgkin disease may affect your later fertility. Talk to your doctor about the chances this will occur, and what you can do before treatment to preserve your fertility.