ABVD is a combination chemotherapy regimen primarily used as first-line treatment for Hodgkin lymphoma, in both early and advanced stages. It contains doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine.

What Drugs Are in ABVD?

The acronym ABVD stands for the four drugs used in the regimen:

• A: Doxorubicin (Adriamycin): an anthracycline that damages DNA.
• B: Bleomycin: an antibiotic that causes DNA strand breaks.
• V: Vinblastine: a vinca alkaloid that inhibits mitosis (a process essential for cell division).
• D: Dacarbazine: an alkylating agent that damages DNA.

These drugs work together to destroy rapidly dividing cells, such as cancer cells, by interfering with their growth and replication.

How Is ABVD Administered?

All four drugs in the ABVD chemotherapy regimen are administered intravenously, typically in an outpatient setting. They may be given through a central line, PICC line, portacath, or a cannula in the arm.

ABVD is given in cycles. Each chemotherapy cycle lasts 28 days (4 weeks). The number of cycles varies depending on the stage of the lymphoma and patient response, but typically ranges from 2 to 6 cycles (2–6 months in total).

Below is an example of a typical ABVD chemotherapy cycle. Your healthcare provider might give you different instructions.

Day 1	Doxorubicin, bleomycin, vinblastine, and dacarbazine are given intravenously. This typically takes 3 hours.
Days 2 to 14	No treatment.
Day 15	Doxorubicin, bleomycin, vinblastine, and dacarbazine are given intravenously. This typically takes 3 hours.
Day 16 to 28	No treatment.

Depending on your scan results, you may or may not need to continue bleomycin after the first few cycles.

When Is ABVD Used in Hodgkin Lymphoma?

ABVD is primarily used as first-line treatment for Hodgkin lymphoma (HL) across multiple stages and patient groups. It is sometimes followed by radiation therapy in early-stage disease.

Early-Stage Hodgkin Lymphoma

ABVD is recommended for limited or non-bulky disease (stages I–II). Patients typically receive 2–4 cycles, often combined with radiation therapy for optimal outcomes. Studies report 12-year freedom from progression rates of about 87% in early-stage cases.

Advanced-Stage Hodgkin Lymphoma

For stages III–IV, ABVD is administered alone for 4–6 cycles. The total number of cycles depends on patient response and tolerability. The 5-year failure-free survival rates are 61%–63%.

How Effective Is ABVD?

ABVD is a well-established frontline chemotherapy regimen for Hodgkin lymphoma, with decades of evidence supporting its efficacy. It is highly effective for most patients with Hodgkin lymphoma, especially in early-stage disease.

Complete Remission and Survival Rates

• Complete Remission: ABVD achieves complete remission rates between 70% and 84% in patients with advanced-stage Hodgkin lymphoma. In early-stage disease, remission rates can reach about 90%. In one phase III trial, 75% of patients with stage I and II HL achieved complete remission with ABVD.
• 5-Year Failure-Free Survival: For advanced disease, the 5-year failure-free survival rate ranges from 61% to 74%. This means that 61% to 74% of patients remain free from disease progression or relapse five years after starting treatment.
• Overall Survival: Long-term overall survival rates are high. For example, a pooled analysis of randomized trials reported a 7-year overall survival of 84% for ABVD. A small retrospective study of patients with advanced HL showed that the 3-year overall survival rate for ABVD was 94%.
• Older Patients: A small study showed that even with dose reductions in older adults, ABVD can yield favorable outcomes, particularly in early-stage disease, with 5-year overall survival rates of 100% in early stages and 66.7% in advanced stages for patients over 60.

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What Are the Common Side Effects?

ABVD chemotherapy, while effective, is associated with a range of side effects. Most are temporary and manageable, but some can be serious or long-lasting. Be sure to discuss all possible side effects from ABVD with your healthcare provider.

Common Side Effects

• Increased risk of infection: Due to lowered white blood cell counts, patients are more susceptible to infections and may develop fever or chills.
• Pain near the infusion site
• Flu-like symptoms
• Fatigue: Tiredness is common and can persist throughout treatment.
• Nausea and vomiting: Many patients experience these symptoms, though anti-nausea medications can help.
• Hair loss: Temporary hair thinning or loss is typical.
• Mouth sores: Painful ulcers or sores in the mouth may occur.
• Loss of appetite and weight changes: Appetite can decrease, sometimes accompanied by taste changes and weight loss or gain.
• Constipation: Difficulty passing stool is a frequent complaint.
• Bruising and bleeding: Lowered platelet counts can cause easy bruising, bleeding gums, or nosebleeds.
• Anemia: Low red blood cell counts can cause paleness, breathlessness, and tiredness.
• Lung toxicity from bleomycin: Occurs in 10% of patients. Symptoms include shortness of breath and rales.
• Pink or red urine from doxorubicin
• Numbness or tingling in hands or feet
• Nail changes
• Cardiotoxicity from doxorubicin: Estimated to occur in up to 9% of patients.

Key Considerations During Treatment

ABVD chemotherapy requires careful management to balance efficacy with safety. Below are essential factors to consider during treatment.

Monitoring

• Blood work is required before each cycle to check blood cell counts, liver function, and kidney function.
• Baseline and periodic echocardiograms and pulmonary function tests are important to check for heart and lung side effects.
• PET scans are necessary to assess response and guide treatment.

Fertility Preservation

Because medications in ABVD chemotherapy can affect fertility, it is important to have a discussion with your healthcare provider about fertility preservation if you want to have children in the future.

Management of Side Effects

There are several strategies to help manage ABVD side effects:

• Hydration and diet: Drink plenty of fluids to flush toxins. Address appetite changes and nausea with small, frequent meals.
• Infection prevention: Avoid crowds, practice hand hygiene, and cook food thoroughly.
• Sun protection: Use SPF 30+ due to photosensitivity from dacarbazine
• Balance gentle exercise with rest

It is not recommended to scuba dive for 1 year after treatment with bleomycin. Your healthcare provider will run tests and tell you when it is safe to do so.

References

1. Advani, R. H., et. al. 2015. Randomized Phase III Trial Comparing ABVD Plus Radiotherapy With the Stanford V Regimen in Patients With Stages I or II Locally Extensive, Bulky Mediastinal Hodgkin Lymphoma: A Subset Analysis of the North American Intergroup E2496 Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 33(17), 1936–1942. https://doi.org/10.1200/JCO.2014.57.8138
2. American Cancer Society. 2024. Treating Classic Hodgkin Lymphoma, by Stage. Accessed on May 15, 2025 at https://www.cancer.org/cancer/types/hodgkin-lymphoma/treating/by-stage.html
3. André, M. P. E., et. al. 2020. Long-term overall survival and toxicities of ABVD vs BEACOPP in advanced Hodgkin lymphoma: A pooled analysis of four randomized trials. Cancer medicine, 9(18), 6565–6575. https://doi.org/10.1002/cam4.3298
4. Bleomycin [package insert]. Fresenius Kabi USA, LLC. Accessed on May 15, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b5806c40-12ce-48e3-8abd-9f8997ef4428
5. Burton, C., et. al. 2024. Paradigm Shifts in Hodgkin Lymphoma Treatment: From Frontline Therapies to Relapsed Disease. In: ASCO Publications: Hematologic Malignancies. DOI: https://doi.org/10.1200/EDBK_433502
6. Cancer Research UK. 2024. ABVD. Accessed on May 15, 2025 at https://www.cancerresearchuk.org/about-cancer/treatment/drugs/abvd
7. Canellos, G. P., et. al. 2009. Long-term follow-up of survival in Hodgkin's lymphoma. The New England Journal of Medicine, 361(24), 2390–2391. https://doi.org/10.1056/NEJMc0906731
8. Dacarbazine [package insert]. Updated 2022. Fresenius Kabi USA, LLC. Accessed on May 15, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b6b97e41-5f15-498c-abfb-d8443ea4d216
9. DeBoer, R. J., et. al. 2020. Treatment of Hodgkin Lymphoma With ABVD Chemotherapy in Rural Rwanda: A Model for Cancer Care Delivery Implementation. In: JCO Global Oncology. DOI: https://doi.org/10.1200/GO.20.00088
10. Doxorubicin [package insert]. Updated 2024. Fresenius Kabi USA, LLC. Accessed on May 15, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e0349f98-42fa-4003-b6d8-a1db1401b0ef
11. EviQ. 2023. Patient information - Hodgkin lymphoma - ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) early stage. Accessed on May 15, 2025 at https://www.eviq.org.au/haematology-and-bmt/lymphoma/hodgkin-lymphoma/57-early-stage-abvd-doxorubicin-bleomycin-vinblas/patient-information
12. Linders, A. N., et. al. 2024. A review of the pathophysiological mechanisms of doxorubicin-induced cardiotoxicity and aging. In: NPJ Aging. DOI: https://doi.org/10.1038/s41514-024-00135-7
13. MacMillan Cancer Support. 2024. Accessed on May 15, 2025 at https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/abvd
14. Makiyama, J., et. al. 2021. Outcomes in Patients with Classic Hodgkin Lymphoma Treated with ABVD: A Single-center Retrospective Study. Internal medicine (Tokyo, Japan), 60(5), 709–718. https://doi.org/10.2169/internalmedicine.5004-20
15. National Cancer Institute. 2023. ABVD. Accessed on May 15, 2025 at https://www.cancer.gov/about-cancer/treatment/drugs/abvd
16. Soldi, L. R., et. al. 2024. The Impact of Bleomycin Deficit on Survival in Hodgkin's Lymphoma Patients: A Retrospective Study. In: Cancer Treatment and Research Communications. DOI: https://doi.org/10.1016/j.ctarc.2024.100790
17. Suwanban, T., et. al. 2023. Survival rates of adult patients with Hodgkin lymphoma who underwent ABVD versus escalated BEACOPP in a resource-limited country: An observational study. Cancer reports (Hoboken, N.J.), 6(8), e1839. https://doi.org/10.1002/cnr2.1839
18. Value-Based Cancer Care. n.d. Accessed on May 15, 2025 at https://www.valuebasedcancer.com/editorial-board/337-rick-lee
19. Vinblastine [package insert]. Updated 2025. Fresenius Kabi USA, LLC. Accessed on May 15, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f073b58e-56d6-4c8d-a2ce-b37719402d77

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• Vinblastine
• Bleomycin
• Dacarbazine

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