ABVD Therapy - Malignant Hematology Chemotherapy

Too few white blood cells (neutropenia)

Low white blood cell count makes you more likely to get infections. You can take these steps to help prevent infection:

• Avoid close contact with people who have the flu or a cold. This includes children.
• Bathe every day. Wash your hands often.
• Keep your mouth clean.
• Keep all cuts and scrapes clean.
• Wear protective clothing when working in the yard.
• Do not cut your cuticles or ingrown nails.
• Do not wear fake nails.
• Do not handle pet litter boxes.

Call your doctor right away if you have any of the following: 

• Temperature over 100.4°F (38°C) that lasts 1 hour or a spike in temperature to 101°F (38.3°C) or higher 
• Other signs of infection: red, swollen, or painful sores; sore throat; painful urination; or chills

Nausea and vomiting

You may have these around the time you get chemo treatment. These side effects will go away in time. You can prevent or manage these with medicine and diet changes.

• You may get anti-nausea medicines. These will control or reduce nausea and vomiting. 
• Avoid fatty or spicy foods. Eating small meals more often instead of eating large meals.
• Drink 6-8 glasses of fluid every day. 

Call your doctor if you have any of these:

• Feel weak or dizzy
• Lose consciousness
• See blood in your vomit
• Cannot drink more than 4 cups of fluid a day

Nausea and vomiting are unpleasant, but they are usually not dangerous. But you must tell you doctor if your nausea or vomiting is not controlled.

Too few red blood cells (anemia)

Low red blood cell count may make you feel short of breath or more tired than usual. When you have less energy, you should:

• Get plenty of rest.
• Limit your activities. 

Call your doctor right away if you feel extra tired when doing your normal activities.

Too few platelets (thrombocytopenia)

When your platelets are low, you may bruise and bleed easier. To prevent bleeding, you should: 

• Use an electric razor to avoid cuts.
• Use a soft toothbrush to clean your teeth.  
• Check with your doctor before using over-the-counter pain medicine. This includes aspirin or ibuprofen. 
• Avoid activities that might cause injury.  

Call your doctor right away if you have any unusual bruising or bleeding.

Hair loss (alopecia)

Your hair may get thinner or even all fall out. Hair loss can happen on all parts of your body. You may start to see these changes about a week after your first treatment. Your hair will grow back after chemo treatments are over.

Some people choose to wear scarves, caps, or wigs when they have hair loss. A short haircut before treatment may help make hair loss easier.

Diarrhea

If you have diarrhea, you must drink plenty of fluids and try to eat bland foods. These include rice, applesauce, bananas, toast, or cereal.

Call your doctor right away if you start having more bowel movements or if they become loose or watery. Your doctor may prescribe medicine to help decrease diarrhea.

Mouth sores (mucositis)

Chemo can cause sores in the mouth and throat. These can be irritating or painful. They can also lead to infection since the mouth is full of germs. It is very important to take good care of your mouth during treatment.

• Drink 6-8 glasses of fluid each day.
• Brush your teeth with a soft toothbrush or cotton swab after meals.
• Avoid mouthwash that contains alcohol.
• Use a mild mouthwash at least 4 times a day. For example: Mix 2 teaspoons of baking soda and 1 teaspoon of salt in an 8 ounce glass of warm water. Then swish it in your mouth and spit it out.
• Avoid hot, spicy or acidic foods and sharp or crunchy foods.
• Cut food into small pieces or moisten with sauces, gravy, or broth.

Call your doctor right away if you are cannot eat, drink, or take your medicines because of mouth sores.

Decreased appetite

It is very important to eat well while getting chemo. When you do not feel like eating, try some of the following tips:

• Eat small meals more often instead a few large meals.
• Keep snacks nearby. You can eat them when you do feel hungry.
• Eat a bedtime snack.
• Try liquid nutritional supplements. Examples are Ensure or Boost.
• Drink 6-8 glasses of fluid a day. Do this even if you cannot eat solid foods.
• Change the form of your food. For example, make a fruit milkshake instead of eating a piece of fruit.
• Talk to a dietitian about good nutrition.

Nervous system changes (neuropathy)

Vincristine may cause weakness, burning, numbness or tingling in the hands or feet. This is called neuropathy.

Tell your doctor if these problems occur or if you have any muscle twitching, involuntary muscle movements, a limp foot or wrist, or difficulty walking or keeping your balance.

Infusion-related side effects

Rituximab can cause fever and chills during infusion. This is most common during the first infusion. Because of this, your first infusion will be longer than later infusions.

Let your doctor or nurse know if you feel warm, chilly, or shaky during or after rituximab. Your nurse may slow down the rituximab infusion and give you medicine to stop the fever and chills. Once you feel better, your nurse will restart the infusion at a slower rate.

Constipation

Vincristine can cause constipation. You can help prevent constipation by drinking plenty of fluids and getting some exercise every day.

Tell your doctor if you have not had a regular bowel movement or if you feel cramps or pain in your belly. If you are constipated, your doctor may prescribe a stool softener or laxative to help move your bowels.

Liver changes

These liver changes may be minor and last a short time. Or they can cause a lot or damage to your liver. Your doctor may order blood tests to make sure your liver is working properly.

Tell your doctor if you have pain in your belly, pass dark colored urine, the white of your eyes looks yellow, or gain or lose more than 5 pounds.

Skin and nail changes

Chemotherapy may cause rash, itching, or redness of the skin. It may also cause patches or changes in nails. Your nails may change color or get more brittle. You may get lines or bands across your nails.

Your skin may also be more sensitive to the sun. Do not stay out in the sun for long, especially between 10 a.m. and 2 p.m. If you go out in the sun, follow these tips:

• Wear a hat and clothes that cover your body, including your arms and legs.
• Use sunscreen with of SPF 15 or higher.

Allergic reaction

Some people have an allergic reaction to rituximab or cyclophosphamide. This is rare. Always remind your doctor if you have had a reaction before.

Tell your doctor or nurse right away if you have any of these during or shortly after a dose:

• Warm sensation
• Facial flushing, skin rash or itching
• Tightness in your chest
• Lower back pain
• Dizziness
• Shortness of breath 

Bladder changes

Cyclophosphamide can cause damage to your bladder.

Tell your doctor if you notice reddish or bloody urine, have pain when you pee, or have stomach pain or cramps.

Drink extra fluids and urinate often to help prevent bladder problems.

Kidney changes

Your doctor may order blood tests or ask for a urine sample to make sure your kidneys are working.

Tell your doctor if you have pain or burning when you urinate, cannot pass urine, or notice reddish or bloody urine. You can help prevent kidney problems by drinking plenty of fluids.

Muscle weakness and joint pain

Vinblastine can cause jaw pain, leg pain, and muscle weakness. Make sure you get enough rest during your treatment.

Call your doctor right away if you have any of these joint or muscle problems.

Lung changes

Your doctor may listen to your breathing to make sure your lungs are working properly.

Tell your doctor if you feel short of breath or have trouble breathing.

Reproductive changes

Chemotherapy can affect the function of sexual organs. Talk to your doctor about how these changes may affect you. Women may want to discuss menopause, infertility, pregnancy, and harvesting eggs. Men may want to discuss infertility and sperm banking.