In 2021, close to 9,000 people are estimated to develop Hodgkin’s lymphoma in the United States. Hodgkin’s lymphoma is a type of cancer that starts in your white blood cells. It’s usually treated with chemotherapy and radiation therapy.

ABVD chemotherapy is one of the most common types of chemotherapy regimen for treating Hodgkin’s lymphoma. The name ABVD is an abbreviation for the four types of drugs used in this treatment:

  • A: doxorubicin hydrochloride (Adriamycin)
  • B: bleomycin sulfate
  • V: vinblastine sulfate
  • D: dacarbazine

In this article, we explain everything you need to know about ABVD chemotherapy and what to expect during treatment and beyond.

More than 150 chemotherapy drugs are FDA-approved to treat cancer. Each of these drugs targets cancer cells in different ways. Combining multiple chemotherapy drugs often gives the best chance of curing cancer.

ABVD is a combination chemotherapy therapy to treat Hodgkin’s lymphoma made up of four drugs.

DrugDrug classAmount per m² of body surface area
doxorubicin hydrochloride (Adriamycin)antitumor antibiotic25 mg
bleomycin sulfateantitumor antibiotic10 units
vinblastine sulfateplant alkaloids6 mg
dacarbazinealkylating agent375 mg

ABVD chemotherapy was first introduced in 1975 and is the current first-line treatment for Hodgkin’s lymphoma in North America. International guidelines recommend ABVD for advanced stage Hodgkin’s lymphoma. For early stage Hodgkin’s lymphoma, ABVD is recommended by itself or in combination with radiation therapy, with differences in dosages based on certain disease factors.

ABVD chemotherapy is usually administered in six to eight chemotherapy cycles that last 28 days each. During each chemotherapy cycle, you’ll receive four chemotherapy drugs intravenously on day 1 and day 15.

ABVD chemotherapy has been a standard part of Hodgkin’s lymphoma treatment for more than 40 years. It’s used to treat early and late stage cancer in both children and adults.

ABVD replaced the MOPP regimen, largely due to a decreased risk of side effects that affect fertility. MOPP is made up of the drugs Mustargen, Oncovin, procarbazine, and prednisone.

Two other regimens called the Stanford V and BEACOPP regimens are also sometimes used to treat Hodgkin’s lymphoma.

With ABVD chemotherapy, the four chemotherapy drugs are given through an IV on days 1 and 15 of your treatment 28-day cycle. This process takes about 3 to 4 hours. Your doctors will recommend a certain amount of cycles based on factors such as your overall health and the stage of your cancer.

The American Cancer Society has provided estimates of the amount of cycles you may need based on different factors. One factor is “favorability,” which means the cancer is:

  • not bulky
  • found in less than three lymph node areas
  • does not cause “B” symptoms
  • your erythrocyte sedimentation rate is not elevated

The estimated number of cycles based on these factors are:

  • favorable early stage cancer: 2 to 4 cycles
  • unfavorable early stage cancer: 4 to 6 cycles
  • advanced stage cancer: at least 6 cycles or more

At the same time you receive the chemotherapy drugs, most patients receive premedications with corticosteroids and antihistamines to prevent side effects.

Your doctor may also recommend that you take prescription anti-nausea pills to prevent vomiting and nausea. It’s often recommended that you take these drugs before and after receiving chemotherapy.

You’ll also have a blood test done either before the first day of your cycle or on the first day to check your white blood cell count.

If your white blood cell count drops too low, you may need to take a medicine called filgrastim. If you need this drug, you’ll receive it as a daily injection under your skin for about 3 to 5 days. A nurse can show you or your caregiver how to administer this injection at home, if necessary.

The drugs administered during ABVD, and other types of chemotherapy, can damage healthy cells and cause many types of side effects. While not everyone will experience all of these side effects, most people will have some. These can include:

Increased risk of infection

ABVD chemotherapy lowers your number of white blood cells and weakens your immune system. It’s important to contact your doctor if you have signs of infection or a fever over 100°F.

Pulmonary toxicity

A potentially serious complication of ABVD is called pulmonary toxicity, or lung damage. Experts think it may be caused by bleomycin.

Your doctor will likely do pulmonary function tests throughout your treatment to test for this side effect.

Neurotoxicity and peripheral neuropathy

Neurotoxicity is another potential outcome that affects many patients receiving ABVD. It can cause peripheral neuropathy, which can feel like numbness or tingling in your fingers or toes. This side effect seems to be caused by vinblastine.

Allergic reaction

It’s possible to develop an allergic reaction during treatments or in the hours afterward. If this happens, it will cause symptoms such as:

Bleeding problems

ABVD chemotherapy can lower the number of platelets in your blood, making it more difficult to clot. You should seek medical attention if you experience tarry stools, tiny red spots on your skin (petechiae), or blood in your urine.

Tissue injury

If ABVD drugs leak out of a vein, this can cause tissue damage, which may feel like burning or stinging. To reduce this risk, your doctor may recommend using a central line, or PICC line, to administer the chemotherapy.

Early menopause

ABVD can affect the ovaries and cause menstrual periods to stop if you’re a woman who is still menstruating. Loss of your period may be permanent, signaling early menopause.

However, there are options to potentially preserve fertility if you’re thinking of having children in the future. Talk with your doctor to see if these options may be right for you.

Heart failure

It’s possible for the drug doxorubicin to cause heart failure. This requires immediate medical attention.

Symptoms of heart failure include:

Other potential side effects

Additional side effects possible with ABVD chemotherapy include:

Undergoing chemotherapy can be a difficult experience. Here are some tips to help you make the process easier.

General tips

  • Apply ice to your injection site if you experience pain or swelling.
  • Avoid crowded areas, and areas that put you at risk of developing an illness, while undergoing treatment.
  • Avoid contact with people who are known to be ill.
  • Call your doctor as soon as possible if you think you have an infection.
  • Wash your hands frequently.
  • Stay out of direct sunlight as much as possible when the sun is at its strongest, and wear sunscreen.
  • Rest as much as possible.
  • Rinse your mouth with one teaspoon of baking soda and equal parts salt mixed with lukewarm water to help soothe mouth sores.
  • Light exercise and staying physically active during treatment can help you feel your best.

Diet tips

  • Avoid sushi, raw fish and meats, and foods that contain raw eggs to minimize your risk of bacterial infection.
  • Minimize your intake of alcoholic beverages.
  • Try eating smaller, more frequent meals instead of three large meals to help with nausea.
  • Skip foods that make you feel nauseous or foods with strong smells.
  • Avoid your favorite foods if they taste strange so you don’t develop a food aversion.
  • Drink lots of water to help prevent dehydration.

Support tips

  • Ask your doctor about specialized support groups that you can join online or in your area.
  • Consider having a family member, friend, or other trusted person come with you for emotional support during your treatment.
  • Seek out counseling with a professional who specializes in people undergoing cancer treatment.
  • Check the Leukemia & Lymphoma Society’s website for local support groups.

If you need radiation therapy, you’ll start it after your final cycle of chemotherapy.

ABVD is very effective for treating early or late stage Hodgkin’s lymphoma. Studies have found that it generally causes manageable side effects, and is associated with a lower risk of infertility or secondary cancer than other regimens.

The overall survival rate of Hodgkin’s lymphoma is more than 90 percent with current treatments. The 5-year overall survival rate in children is more than 96 percent. In adults, the 5-year survival rate is about 84 to 90 percent in both early stage disease and advanced stage Hodgkin’s lymphoma.

Your doctor can help you decide if ABVD chemotherapy is right for you. Factors such as your overall health, age, and stage of cancer can determine the right amount of chemotherapy and whether ABVD is a good option. Your doctor can also tell you about alternative treatment options and give you tips on managing symptoms.