Is abvd working?

[kd50]

Hi, I am a caregiver for 20F with HD stage IIB having ABVD 2 cycles over.
Started with extensive mediastinal lymphodenapathy and itching for almost 5 months before diagnosis.
The WBC count started with 19000 and has been 5700-5000 (Neut - 50-58%) on each test 1 day before next chemo. HBG increased from 10.3 to 12 in the last test.
Is this normal ? I understand the WBC is likely to drop further. Itching subsided completely, but recurred mild after 3rd dose and subsided again.
Is the response positive?
Since WBC stays normal at least when it is tested, is the risk of contracting infection as much as for a normal healthy individual?
What steps can be taken to minimize Bleomycin long term effects - though I dont know much about the effects.
Thanks for reading

[kd50]

Thanks a lot. The doses upto #5 (D1/3rd cycle) have been as follows:
A: 35, 40, 40, 40,40
B: 14, 14, 15, 15, 15
V: 9,    9,   9,   9,  9
D: 400, 400, 400, 400, 400

and the same will be continued for the next one completing the 3rd cycle.
After that some evaluation will be carried out.
WBC was again 5600, Neut - 52%, Platelet count 433000 (decreasing slowly), Sgpt 27, S-Creatinine 0.7
Itching subsided
No fever so far
Hair loss - thinned somewhat
Weight - mild gain from 49 before chemo to 51
There have been no externally observed node swelling, but after 2nd cycle noticed a small one in armpit that has reduced to a small grain size- difficult to locate.
Queries:
1. How is she doing - or may be I am asking too much
2. What tests should be carried out? It was only X-ray chest before and after Port insertion, CT, and biopsy.
3. Is there some way to reduce fibrosis chances?
Thanks again

[PaulMD]

Hi.

The risk of acquiring an infection is significant if the absolute neutrophil count is less than 1000.  This can be computed by multiplying the total WBC count with the percentage of granulocytes or neutrophils (eg. WBC 5000, Neut 50% = ANC 2500). A good response from chemotherapy will be evident on the follow up scans that will be done after about 4 or 5 cycles, aside from the improvement in symptoms.  From the CT scan, we can see objectively if the masses decreased in size.

Bleomycin can have long term complications with the lungs, and the only way to minimize this is to limit the cummulative dose of bleomycin to less than 250 units.  More than this, then the patient runs a high risk of developing pulmonary fibrosis.