Stanford V

Stanford V is the name of a combination of chemotherapy drugs used to treat Hodgkin lymphoma. You may hear it called Stanford 5 or SV. It is made up of the drugs

• Doxorubicin
• Vinblastine
• Mechlorethamine (also called mustine or nitrogen mustard)
• Vincristine
• Bleomycin
• Etoposide
• Prednisone or prednisolone (steroids)

The links above take you to more information about the individual side effects of each drug.

After your chemotherapy you may have a course of radiotherapy.

You usually have Stanford V chemotherapy as cycles of treatment. Each cycle of treatment lasts 4 weeks. You usually have 3 cycles, taking 12 weeks (3 months) in total.

You have Stanford V 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 have the drugs as injections or drips. You have each cycle of treatment in the following way

• On the first day of treatment you have doxorubicin, vinblastine and mechlorethamine
• A week later you have bleomycin and vincristine
• A week later you have doxorubicin, vinblastine and etoposide
• On the next day you have etoposide
• 6 days later you have bleomycin and vincristine

Then you have no treatment until the next cycle starts a week later.  

You take prednisolone or prednisone as tablets every other day for the 12 weeks. From the beginning of week 10 you gradually reduce your dose until you finish treatment after 12 weeks. Your doctor, pharmacist, or specialist nurse will tell you how to reduce the dose.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity.

The side effects associated with Stanford V are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.

More than 10 in every 100 people have one or more of the following effects.

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

• 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.

• Numbness or tingling in fingers and toes affects about 8 out of every 10 people (80%) and 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
• Tiredness during and after treatment – most people find their energy levels are back to normal within 6 months to a year  
• Feeling or being sick happens in just under 7 out of every 10 people (70%), but is usually well controlled with anti sickness medicines
• Constipation can be a problem with vincristine and vinblastine but is usually controlled with laxatives – tell your doctor or nurse if you are constipated for more than 3 days
• A sore mouth – about 2 to 3 days after each treatment you may have red sore skin in your mouth and mouth ulcers that gradually clear up within a couple of weeks
• Sensitivity to sunlight – don’t sit out in the sun, and do cover up or use sun block on exposed skin
• Skin changes, including changes to your nails, and reddening or darkening of your skin
• Hair loss – most people have complete hair loss but the hair will grow back once the treatment ends
• 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 is not harmful
• Watery eyes that may last for several days – your eyes may also be sore
• Women may stop having periods (amenorrhoea) but this may be temporary
• This drug may have a harmful effect on a developing baby so talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• You should not breastfeed while having this drug as it may come through in the breast milk

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

• Inflammation around the drip site – if you notice any signs of redness, pain, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Some people have an allergic reaction while having Stanford V treatment, usually at the first or second treatment – let your treatment team know immediately if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, flushing of the face, or a sudden need to pass urine
• Taste changes
• Loss of appetite
• Loss of fertility– we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Damage to heart muscle from doxorubicin, which is usually temporary but for a small number of people may be permanent – your doctor or nurse will check your heart before and after your treatment
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if the diarrhoea is severe or lasts more than a couple of days

Fewer than 1 in 100 people have these effects.

• Depression
• Headaches
• Jaw pain
• Dizziness
• High blood pressure
• Inflammation of the lungs – you will have lung tests before and during treatment. Tell your doctor or nurse if you have a dry cough or breathlessness, especially in cold weather
• There is a small risk that you may get a second cancer some years after Stanford V treatment

You may have 1 or 2 side effects or several. A side effect may get worse through your course of treatment. Or you may have more side effects as the course of treatment goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much 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 they can help you manage them.

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

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 and yellow fever. 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 for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.