Treatment Regimen and Side Effects of ABVD Chemotherapy

If ABVD chemotherapy is recommended for your cancer, you probably have a thousand questions. How is this given? How often? What are the side effects? Are there any long term consequences? Let's look at some of those questions.

Woman receiving chemotherapy
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What Is ABVD?

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 the ABVD Regimen

The drugs used in this regimen (combination of drugs) include:

  • 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.

A Quick Note About Combination Chemotherapy

You may be wondering, "Why so many drugs? Couldn't one drug alone take care of the cancer?" The reason is that different chemotherapy drugs affect cells at different stages in the process of dividing and multiplying. Using a combination of drugs ensures that cells at different stages in this process are all treated. This is also the reason for using more than one treatment. If a cell happened to be in a rest period — not dividing — during a previous therapy, it's hoped that the next treatment will be able to catch that cell in the process of division.

How Frequently Is ABVD Done?

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.

How Many Cycles Are Required?

How many cycles are required depends on the stage of lymphoma and the presence or absence of certain prognostic factors — factors that give healthcare providers 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.

Tests Required

Before ABVD chemotherapy is started, blood counts, as well as blood tests for kidney and liver function, are done. An echocardiogram is required to test heart function before the treatment begins. As Adriamycin (doxorubicin) may occasionally affect the heart, it's important to have that data for comparison later on during the treatment. A chest X-ray and lung function tests may be used to gauge the fitness of the lungs prior to the use of bleomycin, as this drug can affect the lungs.

During chemotherapy, blood counts are required before every drug injection cycle. Other tests may be repeated as required.

Side Effects

Side effects of chemotherapy are related to the effect of chemotherapy on rapidly dividing cells in addition to cancer cells, and may include:

  • 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 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 healthcare providers recommend medications such as Prilosec, Pepcid, or Nexium, but may 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
  • Fall in 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 healthcare provider immediately.
  • Mouth sores - Mouth sores are very common, but changing your diet in certain ways can help significantly with this discomfort.
  • Diarrhea
  • Constipation - Your healthcare provider 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.

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 healthcare providers 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 healthcare provider 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 healthcare provider about the chances this will occur, and what you can do before treatment to preserve your fertility.
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhang T, Yao Y, Feng F, et al. Comparative effectiveness of different chemotherapy regimens of advanced-stage Hodgkin lymphoma in adults: a network meta-analysis. Cancer Manag Res. 2018;10:6017-6028. doi:10.2147/CMAR.S179356

  2. Stamatoullas A, Brice P, Bouabdallah R, et al. Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly. Br J Haematol. 2015;170(2):179-84. doi:10.1111/bjh.13419

Additional Reading

By Indranil Mallick, MD
 Indranil Mallick, MD, DNB, is a radiation oncologist with a special interest in lymphoma.