ABVD
Regimen
Indication
Hodgkin’s Disease
Therapeutic Intent
Curative
Day
Medication
Dose
25mg/m2
Route
1 + 15
Doxorubicin
IV
1 + 15
Bleomycin
10,000iu/m2
IV
1 + 15
Vinblastine
6mg/m2
IV
1 + 15
Dacarbazine
375mg/m2
IV
Administration Details
Slow bolus injection over 2-3 minutes into the
side-arm of a fast running sodium chloride 0.9%
infusion.
Infusion in 100ml sodium chloride 0.9%. Give
over 30 minutes.
Made in a 50ml sodium chloride 0.9% minibag.
Given over 5- 10 minutes.
Infusion in a minimum of 250ml sodium chloride
0.9% over at least 30 minutes. Protect from light.
Cycle Frequency
Every 28 days
Tests required prior to
initiation of course
FBC, U&E, LFT, Bone profile, glucose, LDH, ECG +/- echocardiogram,
pulmonary function tests.
Tests required prior to
individual cycle
FBC, U&E, LFT
Concurrent Medication
Allopurinol (during 1st cycle)
Antiemetics as per local policy (consider dexamethasone 8mg prior to each
infusion of ABVD)
GCSF support as per local policy
Antimicrobial prophylaxis as per local policy
Laxatives
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Dose Modifications
Hepatic
Serum Bilirubin (micromol/L)
Modification
1.7 – 2.5 x upper limit of normal
2.5 – 4 x upper limit of normal
50% doses of doxorubicin and vinblastine.
25% doses of doxorubicin and vinblastine.
Renal
Limited information – clinical decision
Haematological
No dose modifications for first cycle
Neutrophils (x109/L)
Recent studies have indicated that dose intensity can be maintained by administering
ABVD irrespective of neutrophil count and without the use of GCSF. There are concerns
that GCSF may enhance bleomycin induced lung toxicity. It is recommended that ABVD
be delivered on schedule irrespective of neutrophil count and that clinicians show
caution with respect to the use of GCSF.
Platelets (x109/L)
Modification
>75
No dose modification
<75
Delay all drugs for 1 week and repeat FBC
Grade 2 motor weakness or Grade 3 sensory toxicity – give 50% vinblastine
Higher grades of neurological toxicity – omit vinblastine
Patients with any signs or symptoms of bleomycin pulmonary toxicity must have
pulmonary function tests and a chest X-ray. Bleomycin should be discontinued if the
diffusing capacity is <50% of the predicted value (or the chest X-ray shows evidence of
pulmonary infiltrates or fibrosis)
Check LV ejection fraction if any chest Xray during therapy shows cardiomegaly, or if
signs or symptoms of congestive cardiac failure develop.
If LVEF <50% - discontinue doxorubicin
N.B. the maximum cumulative dose of doxorubicin is 450 – 500mg /m2 – account should
be taken of other anthracyclines the patient may have received.
In the presence of severe (≥grade 3) stomatitis or mucositis, delay therapy until ≤grade 1.
In the presence of severe (≥grade 3) vinblastine-related ileus, delay treatment until
recovery, and then give 75% vinblastine. If recurrent ≥grade 3 ileus develops, discontinue
vinblastine
Neurotoxicity
Pulmonary
Toxicity
Cardiac
dysfunction
Gastro-intestinal
toxicity
Additional Information
Irradiated blood products to be used
References
Adapted from NRCI RATHL trial protocol version 4.0
Author
Pharmacy CNG
Approved & Checked by
Haematology CNG (Review Date = Sept 2017)
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