Example orders for ABVD in Hodgkin lymphoma

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Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.


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 once; 30 minutes prior to chemotherapy
  • Diphenhydramine (Benadryl) 25 mg PO once; 30 minutes prior to chemotherapy
  • Ondansetron (Zofran) 8 mg PO once; 30 minutes prior to chemotherapy
  • Aprepitant (Emend) 125 mg PO on days 1 & 15, 80 mg PO on days 2 to 3, 16-17
  • Dexamethasone (Decadron) 4 mg PO twice per day on days 1 to 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 three times per day prn nausea
  • Prochlorperazine (Compazine) 10 mg PO every 6 hours prn nausea

Clinical scenario & comments:

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