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What ABVD is

ABVD is the name of a chemotherapy treatment used for Hodgkin lymphoma. It is made up of the drugs

You can click on the links above to find out about the side effects of each individual drug.

 

How you have ABVD

You have ABVD drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have ABVD chemotherapy as cycles of treatment. Each cycle of treatment lasts 4 weeks. Depending on your needs, you may have from 4 to 6 cycles, taking 4 to 6 months in total.

You have each cycle of treatment in the following way. On the first day you have all 4 drugs mentioned above as injections or drips into your cannula, central line, portacath or PICC line. You then have a 2 week break. Then you have another dose of the same 4 drugs followed by another 2 week break. This completes one cycle of treatment and you then start another treatment cycle.

The side effects associated with ABVD are listed below. You can use the links (underlined) to find out more about each side effect. Where there is no link please see our cancer drugs side effects section or use the search box at the top of the page.

 

Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

A temporary drop in the number of blood cells made by the bone marrow, causing

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

  • Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • A hypersensitivity reaction happens to as many as half the people having bleomycin, causing a high temperature (fever) and chills while you have the drug – if you have a high temperature the night after your treatment, tell your doctor or nurse when you go for your next dose
  • Skin reactions, such as reddening, darkening or thickening of the skin or nails or dry, peeling skin at the fingertips. You are most likely to develop these side effects 2 to 3 weeks after you start your treatment
  • Hair loss – almost everyone has complete head and body hair loss, which usually begins 2 to 5 weeks after the treatment starts. Your hair will grow back when the treatment ends
  • Loss of appetite
  • Feeling or being sick – doxorubicin and dacarbazine can cause severe sickness, which may begin a few hours after treatment and last for a few days. It is usually possible to control it with anti sickness injections and tablets. If you still feel sick, tell your doctor or nurse because there are other anti sickness medicines you can try
  • A sore mouth – about 2 to 3 days after each treatment you may have red, sore skin in your mouth and mouth ulcers. This gradually clears up within a couple of weeks
  • Your urine may become pink or red for 1 or 2 days after treatment – this is due to the colour of one of the drugs and won't harm you
  • Black or brown discoloration in the skin creases is particularly common in children
  • Sensitivity to sunlight – don’t sit out in the sun, and do make sure you cover up or use sun block on exposed skin
  • Watery eyes occur in about 1 in 4 people with doxorubicin (25%) and may last for several days after the beginning of each treatment
  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug. It is important to talk to your doctor before starting treatment if you are considering having a child in the future
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
  • An allergic reaction happens to 3 people out of 100 who have doxorubicin (3%) – you may have a sudden rash of pink, itchy bumps on your skin and a reddening of the skin along the veins, which should clear up within a few days
  • Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot – this goes away on its own but keep affected areas out of the sun
  • Damage to heart muscle from doxorubicin, which is usually temporary but for a small number of people may be permanent – your doctor will check your heart before and after your treatment
  • Diarrhoea – drink plenty of fluids and if the diarrhoea becomes severe or continues for more than 3 days tell your doctor or nurse because you could get dehydrated
  • Constipation can be a problem with vinblastine, but this is usually well controlled with laxatives – tell your doctor or nurse if you are constipated for more than 3 days
  • Taste changes – food may taste metallic
  • Nails may become darker and white lines may appear on them
  • Fever and chills
  • Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons  – this starts within a few days or weeks and usually goes within a few months of finishing treatment
  • Inflammation of the lungs occurs in about 1 in 10 patients treated with bleomycin (10%) but it is more common in people over 70 – you will have lung tests before and during treatment. Tell your doctor or nurse if you develop a dry cough or breathlessness, especially in cold weather
  • Dacarbazine can cause flu like symptoms for a week after treatment in about 1 in 10 people (10%) – you may have a high temperature (fever), chills, muscle and joint aching, or weakness
  • Sore eyes happen in some people
 

Rare side effects

Fewer than 1 in 100 people have these.

  • Depression
  • Headaches
  • Jaw pain
  • High blood pressure
  • A fast heart rate
  • Difficulty emptying your bladder
  • Dizziness and changes in your vision
  • An allergic reaction to vinblastine – tell your doctor or nurse straight away if soon after having vinblastine you have a sudden cough, wheezing or difficulty breathing
 

Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, and over the counter remedies – some drugs can react together.

ABVD may have a harmful effect on a developing baby and it is not advisable to become pregnant or father a child if you are having this treatment. Talk about contraception with your doctor or nurse before treatment starts.

Breastfeeding is not advisable during this treatment because the drug may come through in the breast milk.

 

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information about ABVD

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 20 March 2013