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The ABVD Chemotherapy Protocol

written by: Eric Haines • edited by: Diana Cooper • updated: 1/11/2011

The ABVD chemotherapy regiment consisting of the drugs adriamycin, bleomycin, vinblastine and dacarbazine is effective in the treatment of Hodgkin lymphoma patients. Common side effects include infection, bleeding, nausea, fatigue and hair loss.

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    ABVD chemotherapy is a treatment regiment given as a first-line treatment of patients with Hodgkin lymphoma. It is named after the initials of the chemotherapy drugs used, which are adriamycin (now known as doxorubicin), bleomycin, vinblastine and dacarbazine. Doxorubicin is a commonly used chemotherapeutic in the treatment of haematological malignancies, many types of carcinomas and soft tissue sarcomas by acting as an anthracycline antibiotic and thus intercalating DNA. Bleomycin is a glycopeptide antibiotic that treats Hodgkin lymphoma, squamous cell carcinomas and testicular cancer by causing breaks in DNA. Vinblastine is an anti-microtubule drug, thus blocks cell division in a variety of cancers that include Hodgkin lymphoma, non-small cell lung cancer, breast cancer, head and neck cancer and testicular cancer. Dacarbazine is an alkylating agent used in the treatment of malignant melanoma, Hodgkin lymphoma, sarcomas and pancreatic carcinomas.

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    Administration of ABVD Chemotherapy

    The administration of the ABVD drug regiment is done on the same day, generally within a 2 hour period in the hospital. Following the treatment, the patient is free to return home and is often given anti-nausea or sickness medications to help them cope with the side effects of the drugs. It is important to note that all the ABVD chemotherapy drugs are administered separately. Doxorubicin and vinblastine are injected into the patient via a saline infusion; whereas, bleomycin and decarbazine are usually given as an infusion, it can also be given via a fast-running saline drip. Following the administration of ABVD, patients are generally given a two week resting period in which no chemotherapy is administered. On the 15th day, the patient returns to the hospital and receives another ABVD dose followed by another two week resting period. The cycles of chemotherapy are often repeated between two and eight times and given over a period of two to eight months.

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    Possible Side Effects of ABVD Chemotherapy

    Like the majority of chemotherapy regiments, ABVD patients often experience side effects. For some patients, little or no side effects are felt, whereas other patients may experience a variety of side effects. The most common side effects include:

    • A lowered resistance to infection: ABVD can reduce the production of white blood cells which puts patients at an increased risk of infection.
    • Bruising or bleeding: ABVD has been shown to reduce the ability of the blood to clot by diminishing the production of platelets. Common signs of this include unexplained bruising, nosebleeds, blood spots, rash and bleeding gums.
    • Anemia: ABVD has also been shown to reduce the number of red blood cells, thus promoting anemia.
    • Nausea and vomiting: ABVD chemotherapy can attack the lining of the stomach and digestive system inducing nausea and vomiting.
    • Fatigue: A large proportion of ABVD patients complain of extreme tiredness, especially during later treatment cycles.
    • Hair loss: Approximately after 3-4 weeks of ABVD patients begin to suffer from hair loss. This hair loss is usually temporary and hair regrowth will occur once therapy has ended.

    Other than the above common side effects some patients may also complain of mouth ulceration, discolored urine, change in taste, peripheral neuropathy, pain at injection site, fever and chills, itchiness, heart problems and respiratory problems.

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    Long-term Effects of ABVD Chemotherapy

    While the short-term side effects of ABVD chemotherapy can be unpleasant to its patients, some of the long-term effects of this chemotherapy regiment can be life changing and even life threatening. Some of the long-term consequences of ABVD include:

    Elevated risk of blood clots: Cancer patients have been shown to be at an elevated risk of developing blood clots or thrombosis. Furthermore, addition of chemotherapy can further enhance this risk of blood clots. Common symptoms of blood clots include pain, rash, swelling in the leg, loss of breath and chest pain.

    Interactions with other medications: Certain medications, whether prescription, over-the-counter, herbal or home remedies, may interact with ABVD chemotherapy drugs and may have harmful effects. For example, ABVD patients taking diclofenac, a non-steroidal anti-inflammatory drug, have been shown to suffer from cardiac deficits, respiratory problems and bleeding.

    Reproductive and developmental complications: both male and female ABVD patients have been shown to have a reduced fertility. However, ABVD has been shown to have a less likelihood of affecting fertility compared to other chemotherapy regiments given to Hodgkin lymphoma patients. Moreover, ABVD has been shown to promote irregular menstruation and even stop menstruation. While in younger women these effects are generally temporary, older women can suffer from permanent loss and thus suffer from menopausal-like symptoms.

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