Example orders for ABVD in Hodgkin lymphoma

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ABVD

ABVD: Adriamycin, Bleomycin, Vinblastine, Dacarbazine

Original references may be found at ABVD

Example regimen #1

• Doxorubicin (Adriamycin) 25 mg/m2 IV on days 1 & 15
  • Given as IV push through running IV.
• Bleomycin (Blenoxane) 10 units/m2 IV on days 1 & 15
  • For cycle 1 only: Bleomycin (Blenoxane) 1 unit test dose infused over 15 minutes. Observe patient for 60 minutes prior to administering the remainder of the full dose.
  • Infuse over 30 minutes after premedication with acetaminophen (Tylenol).
• Vinblastine (Velban) 6 mg/m2 IV on days 1 & 15
  • Given as IV push through running IV.
• Dacarbazine (DTIC) 375 mg/m2 IV on days 1 & 15
  • Given over 60 minutes, with rate adjustments as needed based on patient tolerability.

28-day cycles x 6 cycles

Supportive medications:

• Acetaminophen (Tylenol) 650 mg PO 30 minutes prior to chemotherapy
• Diphenhydramine (Benadryl) 25 mg PO 30 minutes prior to chemotherapy
• Ondansetron (Zofran) 8 mg PO 30 minutes prior to chemotherapy
• Aprepitant (Emend) 125 mg PO on days 1 & 15, 80 mg PO on days 2-3, 16-17
• Dexamethasone (Decadron) 4 mg PO BID on days 1-3, 15-17

Hydration:

• 500 ml NS and/or D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml NS and/or D5W as needed for IV compatibility.

Monitoring:

• On day 1 & 15 of each cycle: CBC with differential, absolute neutrophil count (ANC), comprehensive metabolic panel (including chem 10 & liver function tests (LFTs), LDH, uric acid
• Physician to be notified if LFTs/bilirubin are outside normal limits, ANC <1000, platelets <100.
• Check pulmonary function test (PFTs) with DLCO (diffusing capacity of the lung for carbon monoxide) prior to starting therapy and after 3-4 cycles of therapy. May perform PFTs as soon as after 2 cycles in high risk patients, such as recent smokers.
• Smoking cessation for smokers given risk of bleomycin pulmonary toxicity.
• Echocardiogram prior to start of therapy.
• Restage with PET/CT after 3 cycles of therapy.

Outpatient medications:

• Aprepitant (Emend) & Dexamethasone (Decadron) as described above in Supportive medications.
• Trimethoprim/Sulfamethoxazole (Bactrim SS) 80/400 mg PO daily for PCP prophylaxis
• Ondansetron (Zofran) 8 mg PO TID prn nausea
• Prochlorperazine (Compazine) 10 mg PO Q6H prn nausea

Clinical scenario & comments:

• 28 year-old gentleman with stage IIIAs Hodgkin lymphoma, treated with 6 cycles of ABVD.