ABVD

Any histologically proven Hodgkin’s lymphoma

May be used in combination with rituximab for advanced CD20+ nodular lymphocyte predominant Hodgkin’s lymphoma

Drugs / Dosage: Doxorubicin 25mg/m2 IV Day 1 and 15

Vinblastine* 6mg/m 2 IV Day 1 and 15
(*no cap in this regimen)
Dacarbazine 375mg/m2 IV Day 1 and 15
Bleomycin 10,000iu/m2 IV Day 1 and 15 for 2 cycles, then see Frequency
section

plus, for advanced NLPHL only:

Rituximab 375mg/m2 IV Day 1 (i.e. every 4 weeks)

Other drugs: Allopurinol 300mg po daily - review at 4 weeks

Administration: Doxorubicin injection via fast running infusion of 0.9% sodium chloride
Vinblastine diluted in 50ml 0.9% sodium chloride and infused over 5-10 minutes
Dacarbazine diluted in 500ml sodium chloride 0.9% and infused over 1 hour
Dacarbazine bags and giving sets must be protected from exposure to UV light. Pain on
administration may be minimised by slow infusion.
Bleomycin in 100 ml 0.9% sodium chloride over 15 - 30 minutes
For details on rituximab administration, infused according to standard instructions for the
375mg/m2 dose (e.g. see R-CHOP)

Frequency: 4 weekly cycle, with chemotherapy on Days 1 and 15

Localised disease: 2 – 4 cycles with IF radiotherapy
Advanced disease: 2 cycles, then PET scan and review;
PET-ve patients: continue with 4 further cycles, but consider omitting the bleomycin4
PET+ve patients: urgent MDT review to consider escalation to more intensive regimen

Main Toxicities: myelosuppression; alopecia; mucositis; pulmonary toxicity;

cardiomyopathy (see Comments); peripheral neuropathy; constipation;
skin reactions to bleomycin; rigors during bleomycin infusion (ensure steroid given before
bleomycin); vein pain during dacarbazine infusion (see Administration);
ovarian failure; infertility

Anti-emetics: highly emetogenic, including aprepitant +/- olanzapine

Extravasation: doxorubicin, vinblastine and dacarbazine are all vesicants

Regular FBC Day 1 of every cycle, plus Day 15 of Cycle 1

Investigations: LFTs & U&Es Day 1 of every cycle
LDH Day 1 of every cycle
MUGA/echo see Comments
Lung function tests according to local practice (see Comments)

Reason for Update: aprepitant +/- olanzapine added as 1st line anti-emetic Approved by Chair of Alliance TSSG: Dr J De Vos
Version: 8 Date: 25.9.19
Supersedes: Version 7 Review Date: October 2021
Prepared by: S Taylor Checked by: M Chow

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Comments: Maximum cumulative dose of doxorubicin = 450 - 550mg/m2
A baseline MUGA scan/echocardiogram should be performed where the patient is considered
at risk of having impaired cardiac function e.g. significant cardiac history, hypertension, obese,
smoker, ≥ 70 years old, previous exposure to anthracyclines, previous thoracic radiotherapy.
MUGA scan/echo should be repeated if there is suspicion of cardiac toxicity at any point during
treatment.

Bleomycin pulmonary toxicity is age-dependent, with an increase in frequency and associated

mortality as patient age rises above 40 years. Dose modifications for bleomycin should be
made according to table below. Bleomycin should be used with caution if approaching max
cumulative dose.
Lung function may be monitored throughout treatment, according to local practice.
If patient reports new respiratory symptoms, inform consultant for advice on required
investigations prior to any further administration of bleomycin.
There should be a low threshold for omitting further bleomycin if clinical concerns develop.

Age (years) Maximum Bleomycin dose/week (IU) Max Cumulative Dose (IU)
< 60 30,000 – 60,000 500,000
60 – 69 30,000 – 60,000 200,000 – 300,000
70 – 79 30,000 150,000 – 200,000
80 and over 15,000 100,000

Dose Modifications

Haematological Chemotherapy may be given without delay or dose reduction, and without G-CSF support, in
Toxicity: the presence of uncomplicated neutropenia with agreement of the responsible Consultant1,2.
If platelets < 50 x 109/l, delay chemotherapy until recovered.

Secondary prophylaxis with G-CSF may be used according to the Alliance G-CSF guidelines,
although there is a controversial link between G-CSF use and an increased risk of bleomycin-
induced pulmonary toxicity - when reaching any decision, clinicians should take into account
both case reports that have raised this concern and controlled studies which have not been
able to demonstrate such an effect3.

Renal Impairment: Cockcroft and Gault may be used to predict CrCl. If borderline, an EDTA may be requested.

CrCl (ml/min) Dacarbazine Dose

45 - 60 Give 80%
30 - 45 Give 75%
< 30 Give 70%

CrCl (ml/min) Bleomycin Dose

> 50 Give 100%
10 – 50 Give 75%
< 10 Give 50%

Reason for Update: aprepitant +/- olanzapine added as 1st line anti-emetic Approved by Chair of Alliance TSSG: Dr J De Vos
Version: 8 Date: 25.9.19
Supersedes: Version 7 Review Date: October 2021
Prepared by: S Taylor Checked by: M Chow

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Hepatic Impairment:
Bilirubin (µmol/l) Doxorubicin Dose
20 – 50 Give 50%
51 – 85 Give 25%
> 85 Omit

ALT/AST Bilirubin (µmol/l) Vinblastine Dose

60 – 180 or 26 –51 Give 50% dose
Normal and > 51 Give 50% dose
> 180 and > 51 Discontinue
Consider a dose reduction of dacarbazine, but note that dacarbazine can rarely be
hepatotoxic. If in doubt, contact the Consultant.

Neuropathy: If Grade 2 neuropathy develops, reduce dose of vinblastine to 3mg/m 2.

Lung Toxicity: Bleomycin must be discontinued permanently if any symptoms of lung toxicity.

Skin Toxicity: Severe skin lesions (e.g. desquamation) may require discontinuation of bleomycin

Patient Information: Macmillan/CRUK leaflet for ABVD

References: Follows, G et al; Br J Haem 2014; 166: 34 - 39

1Evens, AM et al; Br J Haematol 2007; 137 (6): 545 - 552
2Boleti, E & Mead, GM; Annals of Oncol 2007; 18 (2); 376 – 380
3Stockley’s Drug Interactions 2019; Bleomycin + Colony-stimulating factors

Advani, R et al; Blood 2013; 122 (26): 4182 – 4188 (NLPHL)

4Johnson, P et al; NEJM 2016; 374: 2419 - 2429

Reason for Update: aprepitant +/- olanzapine added as 1st line anti-emetic Approved by Chair of Alliance TSSG: Dr J De Vos
Version: 8 Date: 25.9.19
Supersedes: Version 7 Review Date: October 2021
Prepared by: S Taylor Checked by: M Chow

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