Side effects of ABVD can be divided into acute (those occurring while receiving chemotherapy) and delayed (those occurring months to years after completion of chemotherapy). Delayed side effects have assumed particular importance because many patients treated for Hodgkin lymphoma are cured and can expect long lives after completion of chemotherapy.
Acute side effects •
Hair loss, or
alopecia, is a fairly common but not universal side effect of ABVD. Hair that is lost returns in the months after completion of chemotherapy. •
Nausea and vomiting can occur with ABVD, although treatments for
chemotherapy-induced nausea and vomiting have improved substantially (see
Supportive care below). •
Low blood counts, or
myelosuppression, occur about 50% of the time with ABVD. Blood cell
growth factors are sometimes used to prevent this (see
Supportive care below). Blood counts are checked frequently while receiving chemotherapy. Any fever or sign of infection that develops needs to be promptly evaluated; severe infections can develop rapidly in a person with a low
white blood cell count due to chemotherapy. •
Allergic reactions to bleomycin can occur. A small test dose of bleomycin is often given prior to the first round of ABVD to screen for patients who may be allergic. •
Neuropathy:
Chemotherapy-induced peripheral neuropathy, a progressive and enduring tingling numbness, intense pain, and hypersensitivity to cold, beginning in the hands and feet and sometimes involving the arms and legs.
Delayed side effects •
Infertility is probably infrequent with ABVD. Several studies have suggested that, while
sperm counts in men decrease during chemotherapy, they return to normal after completion of ABVD. In women,
follicle-stimulating hormone levels remained normal while receiving ABVD, suggesting preserved ovarian function. Regardless of these data, fertility options (e.g.
semen cryopreservation,
oocyte cryopreservation,
embryo cryopreservation) should be discussed with an
oncologist before beginning ABVD therapy. •
Pulmonary toxicity, or
lung damage, can occur with the use of
bleomycin in ABVD, especially when
radiation therapy to the chest is also given as part of the treatment for Hodgkin lymphoma. This toxicity develops months to years after completing chemotherapy, and usually manifests as
cough and
shortness of breath. High concentrations of oxygen, such as those often used in surgery, can trigger lung damage in patients who have received bleomycin, even years later.
Pulmonary function tests are often used to assess for bleomycin-related damage to the lungs. One study found bleomycin lung damage in 18% of patients receiving ABVD for Hodgkin lymphoma. Retrospective analyses have questioned whether bleomycin is necessary at all; however, at this point it remains a standard part of ABVD. •
Cardiac toxicity, or
cardiomyopathy, can be a late side effect of
adriamycin. The occurrence of adriamycin-related cardiac toxicity is related to the total lifetime dose of adriamycin, and increases sharply in people who receive a cumulative dose of more than 400 mg/m2. Almost all patients treated with ABVD receive less than this dose (for 6 cycles of ABVD, the cumulative adriamycin dose is 300 mg/m2); therefore, adriamycin-related cardiac toxicity is very uncommon with ABVD. •
Secondary malignancies. Patients cured of Hodgkin lymphoma remain at increased risk of developing other (secondary) cancers. Treatment-related
leukemias are uncommon with ABVD, especially as compared with MOPP. Many of these second cancers were lung cancers or, in women, breast cancers, emphasizing the importance of
smoking cessation and regular
preventive care after completion of treatment. Radiation and chemotherapy probably both play a role in the development of these secondary malignancies; the exact contribution of chemotherapy such as ABVD can be difficult to tease out. ==Supportive care==