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Treatment Name: ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine)

ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine) is a Chemotherapy Regimen for Hodgkin's Lymphoma

How does ABVD chemo work?
Each of the medications in ABVD is designed to kill lymphoma cells.

A - Adriamycin (doxorubicin)
B - Bleomycin
V - Vinblastine
D - Dacarbazine

Goals of ABVD therapy:
The ABVD regimen is given to shrink enlarged lymph nodes and decrease symptoms from Hodgkin Lymphoma. ABVD chemotherapy is commonly given with the goal of cure.

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Schedule

  • Doxorubicin is an intravenous (I.V) push or infusion, usually given over 15 minutes on Days 1 and 15
  • Bleomycin is an I.V. infusion, usually given over 10 minutes on Days 1 and 15
  • Vinblastine is an I.V. infusion, usually given over 5 to 10 minutes on Days 1 and 15
  • Dacarbazine is an I.V. infusion, usually given over 30 minutes on Days 1 and 15

Typically all four drugs are given on Days 1 and 15 of each cycle, unless the doctor discontinues one or more for side effects or toxicity.

Estimated total infusion time for ABVD chemotherapy:

  • Up to 3 hours
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability.  Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

The ABVD chemotherapy regimen is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, ABVD may be given in the hospital if someone is too sick for outpatient treatment.

ABVD is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease and response to previous cycles. Duration of therapy may last up to six months, depending upon response, tolerability, and number of cycles prescribed.

Radiation may be given after completion of all planned cycles of ABVD.

Click here for common ABVD starting doses.

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Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported clinically significant side effects with ABVD are seen here. Side effects sometimes have percentage ranges [example: hair loss occurs 15 – 58%] because they differed between clinical studies.

  • Hair loss, (15 - 58%)
  • Low white blood cell count, (10 - 38%)
  • Nausea or vomiting, (9 - 15%)
  • Mouth sores, (1 - 16%)
  • Dry cough, (11%)
  • Infections, (2 - 11%)
  • Anemia [low red blood cell count], (1 - 7%)
  • Shortness of breath during physical activity, (3%)
  • Nerve pain, (1 - 3%)
  • Increased bleeding risk [low platelet count; thrombocytopenia], (0 - 2%)

In general, it is rare for patients to stop ABVD chemotherapy due to intolerable side effects and almost all patients receive all planned cycles of treatment.

Hair loss from ABVD usually begins 10 - 14 days after the first doses. ABVD hair loss is often noticeable, and a wig or hair piece may be desired to camouflage the absence of hair until it grows back. Hair usually begins to grow back within a few weeks of the last cycle of ABVD chemo.

Heart problems may be a long term side effect of ABVD chemotherapy. The risk of heart problems increases based upon how much radiation (dosed in Gray, or "Gy"), and how much doxorubicin (Adriamycin, the "A" in ABVD, dosed in milligrams) is given.

Side effect videos Side Effect Videos
Hair LossHair LossNausea and VomitingNausea and VomitingAnemiaAnemiaPainPainFatigue Fatigue ConstipationConstipation

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Monitoring

How often is monitoring needed?  
Labs (blood tests) may be checked before treatment and on each day that chemotherapy is given. Labs often include: Complete Blood Count (CBC), and a Comprehensive Metabolic Panel (CMP).  Pulmonary function tests (PFT's) are performed prior to treatment to ensure that your lungs are healthy enough to receive bleomycin.  These may be rechecked during treatment and at the completion of treatment during routine follow-up.

How often is imaging needed? 
Imaging may be checked before treatment, after 2 to 4 cycles of chemotherapy, and at the completion of chemotherapy.  Imaging may include: X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment? 
Depending upon the results, your doctor may advise to continue chemotherapy as planned, or delay or switch therapy.

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ChemoExperts Tips

  • Prior to the first dose of bleomycin on Cycle 1 only, a test dose of bleomycin may be given to ensure that no drug reactions occur. If the test dose is tolerated, the remainder of the full dose will be given. This does not need to be repeated with every cycle
  • Treatment with ABVD may interrupt normal menstrual cycles in women and decrease sperm count in men. Prior to starting treatment with ABVD, discuss with you doctor what fertility preservation options you have
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for Hodgkin Lymphoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine). Depending upon your income, they may be able to help cover the cost of:

  • Doxorubicin
  • Bleomycin
  • Vinblastine
  • Dacar­bazine

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine)

Individual Drug Label Information

Doxorubicin (Adriamycin®)

  • Doxorubicin is administered as an intravenous infusion and is red in color
  • Can affect heart function. A heart study (echocardiogram) may be required before receiving the first dose
  • Dosage may be reduced in patients with poor liver function
  • Has been linked to the development of other cancers in a small number of people (1.5% chance at 10 years)
General Doxorubicin (Adriamycin) Side Effects
  • Nausea, vomiting, diarrhea, and mouth sores (stomatitis)
  • Leakage into skin or surrounding muscle during infusion may cause severe irritation (extravasation)
  • May temporarily turn urine orange
  • Hair loss, which is usually reversible
  • Increased risk of infection due to decrease white blood cell count (neutropenia)
  • Click on the doxorubicin (Adriamycin) package insert for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossPainPainNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Bleomycin (Blenoxane®)

  • Bleomycin is an intravenous (I.V.) infusion
  • FDA Boxed Warning for severe lung toxicity. This risk is increased in smokers, patients above the age of 40 years, history of radiation therapy to the chest, use of supplemental oxygen, and patients with high lifetime doses of bleomycin
  • May cause wheezing or shortness of breath. A test dose (1 unit) may be given on Cycle 1, Day 1 to make sure that the remaining dose if safe to give.
  • Dosage adjustments may be required for kidney function 
General Bleomycin (Blenoxane) Side Effects
  • Can cause various skin changes such as rash, or increased skin pigmentation. Skin changes, when they occur, may not develop until the second or third week of treatment
  • Mouth sores
  • Hair loss
  • Trouble breathing
  • Click on the bleomycin (Blenoxane) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Hair LossHair LossPainPain

See DailyMed package insert.

Vinblastine

  • ​Vinblastine MUST only be given by intravenous infusion (by vein) usually over 1 to 5 minutes. May NOT be administered any other way. Vinblastine will cause death if administered into spinal fluid (intrathecal)
  • Dosage adjustments may be required for patients with liver problems
  • May interact with other medications you are taking, such as antifungal medicines. Ask your doctor or pharmacist to review them
General Vinblastine Side Effects
  • Nerve pain in hands or feet may increase after each dose. It is usually reversible if treatment is stopped or dose is adjusted
  • Low white blood cell count; this may temporarily increase your risk for infection
  • Patients should immediately report and symptoms of fever, chills, sore throat or mouth to their doctor
  • Constipation; the use of fiber supplements or laxatives may be useful to prevent or treat constipation during this treatment.
  • Hair loss
  • Leakage into skin or surrounding muscle may cause severe irritation (extravasation)
  • Click on the vinblastine package insert below for reported side effects and possible drug interactions

Side Effect Videos
Hair LossHair LossConstipationConstipationPainPainNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Dacar­bazine (DTIC)

  • Dacarbazine is an intravenous (I.V.) infusion
  • FDA Boxed Warning for low blood counts, most commonly low white blood cells and low platelets FDA Boxed Warning for liver toxicity
  • Dosage adjustments may be required for kidney function 
General Dacarbazine (DTIC) Side Effects
  • Dacarbazine is associated with a high risk of nausea and vomiting. Be sure to always have a supply of anti-nausea medications at home
  • Weight loss
  • Hair loss
  • Click dacarbazine (DTIC) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Hair LossHair Loss

See DailyMed package insert.

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References

1. Bonadonna G, Bonfante V, Viviani S, et al. ABVD Plus Subtotal Nodal Versus Involved-Field Radiotherapy in Early-Stage Hodgkin’s Disease: Long Term Results. J Clin Oncol. 2004;22:2835-2841.

2. Engert A, Plutschow A, Eich HT, et al. Reduced Treatment Intensity in Patients with Early-Stage Hodgkin’s Lymphoma. N Engl J Med. 2010;363:640-652.

3. Eich HT, Diehl V, Gorgen T, et al. Intensified Chemotherapy and Dose-Reduced Involved-Field Radiotherapy in Patients With Early Unfavorable Hodgkin’s Lymphoma: Final Analysis of the German Hodgkin Study Group HD11 Trial. J Clin Oncol. 2010;28:4199-4206.

Created: August 24, 2015 Updated: April 22, 2017

What is Hodgkin's Lymphoma?

Hodgkin Lymphoma is a disease of the white blood cells known as B-lymphocytes which are normally found in lymph nodes, blood, and throughout the body. Hodgkin lymphoma most commonly affects lymph nodes found in the neck or center of the chest. There are different types of Hodgkin lymphoma, many of which are rare. Most Hodgkin lymphomas are diagnosed by the presence of a specific cell known as the Reed-Sternberg cell. Known causes of lymphoma may include family history of Hodgkin lymphoma, history of infection with the Epstein-Barr virus, use of immunosuppressive medications, or HIV infection, while some causes are still unknown. The stage of Hodgkin lymphoma can vary at diagnosis and throughout treatment. Stages of Hodgkin’s lymphoma include I, II, III, IV. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1. Bonadonna G, Bonfante V, Viviani S, et al. ABVD Plus Subtotal Nodal Versus Involved-Field Radiotherapy in Early-Stage Hodgkin’s Disease: Long Term Results. J Clin Oncol. 2004;22:2835-2841.

2. Engert A, Plutschow A, Eich HT, et al. Reduced Treatment Intensity in Patients with Early-Stage Hodgkin’s Lymphoma. N Engl J Med. 2010;363:640-652.

3. Eich HT, Diehl V, Gorgen T, et al. Intensified Chemotherapy and Dose-Reduced Involved-Field Radiotherapy in Patients With Early Unfavorable Hodgkin’s Lymphoma: Final Analysis of the German Hodgkin Study Group HD11 Trial. J Clin Oncol. 2010;28:4199-4206.

Common Starting doses

  • Doxorubicin 25 mg/m2 intravenous push or infusion over 15 minutes on Days 1 and 15
  • Bleomycin 10 units/m2 intravenous infusion over 10 minutes on Days 1 and 15
  • Vinblastine 6 mg/m2 intravenous infusion over 5 to 10 minutes on Days 1 and 15
  • Dacarbazine 375 mg/m2 intravenous infusion over 30 minutes on Days 1 and 15

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.