What are the side effects of ABVD chemotherapy?

Question

Hello doctor,

My 26-year-old cousin was diagnosed with Hodgkin's lymphoma and completed six cycles of ABVD chemotherapy a few weeks ago. His treatment included the following medications:

Doxorubicin (Anthracycline antibiotic).
Bleomycin (Antitumor antibiotic).
Vinblastine (Vinca alkaloid).
Dacarbazine (Alkylating agent).

Recently, he has developed a persistent cough and night sweats again. His erythrocyte sedimentation rate (ESR) is elevated at 42 millimeters per hour, and his lactate dehydrogenase (LDH) levels are mildly raised.

Could these new symptoms suggest an early relapse, bleomycin-induced lung toxicity, or just post-treatment inflammation?

What is the best protocol for imaging and laboratory tests to evaluate such post-chemotherapy complaints during the first few months after treatment?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Post-chemotherapy inflammation in Hodgkin's lymphoma (HL) can present in various forms, including new or worsening lymph node swelling, persistent fever, pain, fatigue, night sweats, and an increased susceptibility to infections due to reduced blood cell counts. Some patients may also develop pulmonary complications such as pneumonitis or pulmonary fibrosis, especially following treatment with Bleomycin (an antitumor antibiotic) or radiation therapy.

Relapsed Hodgkin's lymphoma can show symptoms similar to those at the time of initial diagnosis. It is important to remain vigilant and seek medical advice promptly if concerning symptoms arise.

Common signs of relapse may include:

Swollen lymph nodes.
Drenching night sweats.
Unexplained weight loss.
Persistent fatigue.
Generalized itching.
New or worsening pain.

In certain cases, a relapse may also present with gastrointestinal changes, skin rashes (particularly in cases of cutaneous lymphoma), or other systemic symptoms resembling the initial illness.

Evaluation after chemotherapy.

Evaluating post-chemotherapy complaints requires a comprehensive and multidisciplinary approach. This includes:

Assessing both physical and psychological symptoms.
Monitoring for late-onset complications.
Evaluating the effectiveness of completed treatment.
Conducting routine follow-ups with the oncology team.

Tools such as the Edmonton Symptom Assessment System (ESAS) can help in structured symptom tracking. Depending on symptoms, additional imaging studies (such as PET-CT (Positron emission tomography - computed tomography) or CT (computed tomography scans) and laboratory tests (including complete blood count, lactate dehydrogenase, and erythrocyte sedimentation rate) may be required.

Probable causes:

Hodgkin's lymphoma (HL).
Post-treatment inflammatory response.
Drug-related toxicity (like Bleomycin-induced pulmonary toxicity).

Probable diagnosis:

Relapsed Hodgkin's lymphoma.
Chemotherapy-induced complications.

Please consult your oncologist promptly for a clinical evaluation and further testing.

I hope this helps.

Thank you.