Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

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ABVD

ABVD is the name of a chemotherapy combination that includes:

  • A – doxorubicin (Adriamycin)
  • B – bleomycin
  • V – vinblastine
  • D – dacarbazine (DTIC)

It is a treatment for Hodgkin lymphoma.

How ABVD works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have ABVD

You have ABVD into your bloodstream (intravenously).

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have ABVD

You have ABVD chemotherapy as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.

Each cycle lasts 4 weeks (28 days). You have chemotherapy on day 1 and day 15. You might have between 2 and 8 cycles, taking 2 to 8 months in total. 

A cycle of treatment looks like this:

Day 1
  • you have doxorubicin as an injection into your bloodstream (intravenously)
  • you have bleomycin as a drip into your bloodstream over 30 minutes
  • you have vinblastine as a drip into your bloodstream over 5 to 10 minutes
  • you have dacarbazine as a drip into your bloodstream over 30 minutes
Day 2 to 14
  • you have no treatment
Day 15
  • you have the same 4 drugs as above
Day 16 to 28
  • you have no treatment

You then start a new cycle of treatment.

Some people may not need to continue bleomycin chemotherapy after the first couple of cycles. This is dependant on your PET scan results. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

High temperature or chills

You might get a high temperature. Or you might feel cold or start shivering (chills). 

Contact your advice line straight away if you have signs of infection, including a temperature above 37.5C or below 36C.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Less commonly one or both corners of your mouth might get sore, red, crack and crust. This can be itchy and painful. Let your doctor or nurse know if this happens.

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after having this treatment.

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Changes to your fingertips

Your fingers tips might get tender, swell, redden and the skin might get hard and thicken.

Nail changes

You might have nail changes such as ridges or darkening. Tell your doctor or nurse if you have any nail changes. They can recommend how best to care for them.

Soreness, redness and peeling on the palms and soles of the feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.

Skin problems 

Symptoms of skin problems can include a rash, blistering, thickening, itching and reddening of the skin. Your skin might get darker in colour, you might develop stretch marks, or raised bumps on the skin. 

Less often areas of skin might peel, leaving your skin sore and inflamed. Your skin might also be sensitive at previous radiotherapy sites and to the sun, but this is rare.

Let your doctor or nurse know if you get any skin rash or a rash that gets worse, or you’re worried about any other changes to your skin.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Heart changes 

Tests might show you have changes to your heart rhythm, the way your heart pumps blood around the body and the electrical activity. Your doctor will make sure it is safe for you to start treatment.

Less commonly you might have symptoms if your heart is not pumping blood around the body properly. These symptoms include breathlessness, cough and swelling in your ankles, feet and lower parts of your legs.

Let your doctor or nurse know if you notice any of these changes. 

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Lung problems

You may develop lung problems such as scarring or inflammation of the lungs (pneumonitis). Less commonly you might have difficulty breathing.

Let your doctor or nurse know straight away if you suddenly become breathless, have changes to your breathing, feel tired and weak, develop flu-like symptoms or a cough.

Red or pink urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • a serious reaction to an infection (sepsis) signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering - contact your advice line straight away if you have any of these symptoms
  • a reaction during the infusion – you might get a rash, shortness of breath, redness or swelling of the face and dizziness – tell your team straight away if this happens
  • blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • eye infection (conjunctivitis) – your eyes may feel gritty, itchy, sticky from pus, watery and look red
  • tummy (abdominal) pain
  • headache
  • inflammation and irritation around the drip site
  • inflammation and irritation of the lining of the food pipe – symptoms might include heartburn, bloating, and burping

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • lack of fluid in the body (dehydration) – signs include feeling dizzy, not passing enough urine and dark coloured urine
  • bleeding in your stomach or gut (digestive system) which might cause bloody or dark poo
  • pain at the tumour site or the area around it
  • dizziness or confusion
  • low blood pressure – you might feel dizzy, lightheaded or faint
  • muscle or joint pain
  • problems passing urine – you might pass urine more frequently, be difficult and painful, unable to pass urine, not fully emptying your bladder, or you might not be passing enough urine
  • flu like symptoms – signs include feeling tired, high temperature (fever), shivering or shaky (chills) and muscle aches and pains
  • hardening of the tissue at the injection site
  • blisters and calluses on areas that often get rubbed such as the elbows
  • narrowing, thickening and hardening of the blood vessel walls

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of fertility 

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
09 Jun 2020
Next review due: 
09 Jun 2020
  • Electronic Medicines Compendium 
    Accessed April 2020

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Guidelines for the first line management of classical Hodgkin lymphoma
    G A Follows and others
    British Journal of Haematology, April 2014. Volume 166, Issue 1, Pages 34 - 49

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