Side Effects of ABVD Chemotherapy Regimen
ABVD chemotherapy (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) has several significant side effects, with bleomycin-induced pulmonary toxicity and myelosuppression being the most concerning acute effects, while cardiac disease and secondary malignancies represent the most serious long-term complications. 1
Acute Side Effects
Myelosuppression
- Most common immediate side effect of ABVD 1
- Associated with increased risk of infections
- Typically resolves after completion of treatment
- Does not typically require growth factor support 2
- Can administer full-dose ABVD regardless of granulocyte count without significant delays or infections 2
Pulmonary Toxicity
- Bleomycin-induced pulmonary toxicity (BPT) is well-documented 1
- Risk factors include:
- Older age
- Cumulative bleomycin dose
- Pulmonary irradiation
- Prior history of lung disease
- Pulmonary function tests, including diffusing capacity of the lungs for carbon monoxide (DLCO), should be monitored during treatment 1
- Growth factors may increase the incidence of pulmonary toxicity 1
Other Acute Side Effects
- Nausea and vomiting (related to dacarbazine)
- Hair loss (related to doxorubicin)
- Peripheral neuropathy (related to vinblastine)
- Fatigue
- Mucositis
Long-Term Side Effects
Cardiovascular Disease
- Mediastinal irradiation and anthracycline-based chemotherapy (doxorubicin) are highest risk factors 1
- Cardiac abnormalities may be detected within first 5 years after treatment
- Incidence significantly increases 10 years after treatment 1
- Risk factors include:
- Age at treatment
- Hypercholesterolemia
- Hypertension
- RT dose to coronary artery origins 1
Secondary Malignancies
- Second malignancy is the leading cause of death among long-term HL survivors 1
- ABVD has lower risk of secondary leukemia compared to older regimens like MOPP 1
- Solid tumors account for majority of second malignancies
- Risk remains elevated 25+ years after initial HL diagnosis 1
- Radiation therapy is main contributor to solid tumor risk 1
Endocrine Effects
- Hypothyroidism occurs in approximately 50% of patients who received neck or upper mediastinal irradiation 1
- Thyroid function tests should be performed annually 1
Reproductive Effects
- ABVD is only rarely associated with infertility, unlike more intensive regimens (e.g., BEACOPP) 1
- Women who maintain short-term fertility may experience premature menopause 1
- Fertility preservation should be considered before treatment 1
Monitoring and Management
During Treatment
- Regular complete blood counts to monitor myelosuppression
- Pulmonary function tests for patients receiving bleomycin 1
- Cardiac evaluation (echocardiogram) before starting treatment 1
- Avoid unnecessary growth factor support with ABVD 1, 2
Long-term Follow-up
- Annual blood pressure monitoring 1
- Aggressive management of cardiovascular risk factors 1
- Baseline stress test or echocardiogram at 10-year intervals after treatment 1
- Annual thyroid function tests 1
- Age-appropriate cancer screening with heightened vigilance
Clinical Pearls
- ABVD is associated with lower rates of sterility and secondary leukemia compared to older regimens like MOPP 1
- Full-dose ABVD can be administered without dose reductions or growth factors, even with neutropenia 2
- Dacarbazine cannot be safely omitted from the ABVD regimen without substantial loss of efficacy 3
- Long-term follow-up by an oncologist is essential after completion of treatment due to potential late effects 1
- Counseling about survivorship issues should be an integral part of follow-up care 1
Comparison with Other Regimens
- ABVD has fewer cumulative doses of doxorubicin and bleomycin than hybrid regimens, reducing risks for infertility, secondary neoplasms, and cardiac/pulmonary toxicity 1
- Stanford V is a brief but dose-intensive regimen with fewer cumulative doses of doxorubicin and bleomycin 1
- BEACOPP is more aggressive and associated with higher toxicity, including increased risk of leukemia 1