From the Research
For ABVD chemotherapy, treatment can typically proceed if the absolute neutrophil count (ANC) is ≥1,000 cells/mm³ on the day of treatment, as supported by the study published in 2007 1. This approach allows for the maintenance of dose intensity without the routine use of growth factor support, such as G-CSF, unless there is a history of febrile neutropenia or significant neutropenia causing treatment delays. The study found that the median ANC on all ABVD treatment days was 0.925 x 10(9)/l, and was <0.5 x 10(9)/l on 26% of treatment days, yet the incidence of febrile neutropenia was low at 0.44% 1.
Key points to consider:
- ABVD is often administered without routine growth factor support unless there is a history of febrile neutropenia or significant neutropenia causing treatment delays, partly because bleomycin-induced lung toxicity may be exacerbated by G-CSF use 2, 3.
- If a patient experiences febrile neutropenia or significant treatment delays due to neutropenia, growth factor support may be considered for subsequent cycles 4.
- Blood counts should be monitored regularly throughout treatment, typically before each cycle, to assess the need for growth factor support or treatment delay 5.
- ABVD is generally administered every 2 weeks for a total of 2-6 cycles depending on the stage of Hodgkin lymphoma and the treatment protocol being followed.
It is essential to weigh the benefits of maintaining dose intensity against the potential risks of neutropenia and febrile neutropenia, as well as the potential for bleomycin-induced lung toxicity when considering the use of G-CSF in patients receiving ABVD chemotherapy 1.