Hodgkin Lymphoma - ABVD Chemotherapy Side Effects

ABVD is a chemotherapy regimen used in the first-line treatment of Hodgkin lymphoma.

The Regimen Contains:
A: doxorubicin (Adriamycin)
B: Bleomycin
V: Vinblastine
D: Dacarbazine (DTIC)

ABVD is given in cycles. Each cycle lasts 28 days and consists of 2 treatments. Treatments are given on the 1st and 15th days of the cycle. All four of the chemotherapy drugs are given intravenously. The total number of cycles given depends upon the stage of the disease and how well the patient tolerates chemotherapy. Doses may be delayed because of neutropenia, thrombocytopenia, or other side effects.

Side effects
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 who has ABVD chemotherapy:
  • Nausea and vomiting may be experienced with ABVD. It can begin shortly after chemotherapy is given. The duration varies from person to person but is usually24 to 72 hours.
  • Heartburn or acid reflux
  • Hair loss - Temporary and total loss of body hair usually occurs two to three weeks after treatment begins. Hair that is lost returns in the months after completion of chemotherapy.
  • Flu-like symptoms such as: feeling hot, cold or shivery, having a headache and aching may occur during or several hours after the treatment.
  • Constipation or Diarrhea - Constipation (due to vinblastine) is more likely and can be treated by taking laxatives such as Miralax as well as foods that promote bowel movements.
  • Mouth sores can occur and can be minimized with mouth rinses by combining ½ teaspoon of salt and ½ teaspoon of baking soda in a cup of warm water.
  • Increased sensitivity to sunlight during treatment and for several months afterwards.
  • Patients commonly experience neutropenia (low white blood cell count) as a result of this treatment. This will make the patient more likely to get an infection. Neutropenia is often managed by treatment delays, or blood growth factors support (e.g. Neulasta, Neupogen).
  • Thrombocytopenia (low blood platelet count). Platelets are cells that help the blood to clot. Increased bruising and bleeding may occur.
  • Anemia (low red blood cells). Red blood cells carry oxygen around the body. If the number of red blood cells is low, the patient may be tired and breathless. Erythropoietin stimulates red blood cell production and can help reduce or prevent this side effect.
  • Pink-red colour of urine for up to 48 hours after the treatment. This is due to the colour of doxorubicin.
  • Allergic reactions to bleomycin can occur. Occasionally, bleomycin causes long thin streaks that look a bit like scratches to appear on one or more areas of skin.
  • Dacarbazine in ABVD can cause irritation or pain along the vein where it is infused, rarely, tissue damage may occur.
  • Changes in Peripheral Blood Flow - Bleomycin and Vinblastine may cause changes in the blood flow, hands and feet may become white or red in color, and hypersensitive to cold.
  • ABVD may cause the cancer cells to break down quickly. This releases uric acid (a waste product) into the blood. Too much uric acid can cause swelling and pain in the joints, which is called gout. Allopurinol (Zyloric) can help prevent this. Drinking at least two litres of fluid a day will also help.
  • Peripheral neuropathy can occur with the use of Vinblastine, symptoms include, a progressive and enduring tingling numbness, sensory loss in fingers and/or toes, beginning in the hands and feet and sometimes involving the arms and legs
  • Pulmonary toxicity and impaired lung function, can occur with the use of bleomycin in ABVD. This toxicity develops months to years after completing chemotherapy, and usually manifests as cough and shortness of breath. All patients complaining of shortness of breath require a CXR prior to further administration of Bleomycin.
  • Cardiac toxicity, or cardiomyopathy, can be a late side effect of doxorubicin (Adriamycin), leading to congestive heart failure. The occurrence of doxorubicin-related cardiac toxicity is related to the total lifetime dose of doxorubicin, and increases sharply in people who receive a cumulative dose of more than 400 mg/m2. Almost all patients treated with ABVD receive less than this dose (for 6 cycles of ABVD, the cumulative adriamycin dose is 300 mg/m2).The incidence of cardiac toxicity is about 4% when the dose of doxorubicin is 500–550 mg/m², 18% when the dose is 551–600 mg/m² and 36% when the dose exceeds 600 mg/m².
  • Fertility / Menopause - The ABVD regimen may interfere with the normal menstrual cycle (period) in women and may stop sperm production in men.

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