If you’re preparing to start ABVD chemotherapy, you may already have been warned that your hair could become thinner or fall out during treatment.

That naturally raises another question: can you use a cold cap during ABVD chemotherapy to help save your hair?

In most cases, scalp cooling is not recommended for people receiving ABVD because ABVD is used to treat Hodgkin lymphoma, a type of blood cancer.

This is not because cold capping cannot be used with doxorubicin – one of the main hair-loss-causing chemotherapy drugs within ABVD. Doxorubicin is also used to treat other types of cancer where scalp cooling may be an option.

The important difference is the type of cancer being treated.

Leading cancer organisations, including Macmillan Cancer Support, Cancer Research UK and Lymphoma Action, advise against scalp cooling for people with lymphoma and other blood cancers because of the possibility that cancer cells could be present in the blood vessels of the scalp.

In this guide, we’ll explain:

• what ABVD chemotherapy is
• whether ABVD causes hair loss
• why scalp cooling isn’t usually recommended for Hodgkin lymphoma
• why doxorubicin can sometimes be cold capped when used for other cancers
• other common side effects of ABVD
• ways to prepare for and manage chemotherapy-related hair loss
• where to get advice before your treatment begins

What is ABVD chemotherapy?

ABVD is a combination chemotherapy treatment most commonly used to treat Hodgkin lymphoma.

Its name comes from the four chemotherapy drugs it contains:

• A – Adriamycin® (doxorubicin)
• B – Bleomycin
• V – Vinblastine
• D – Dacarbazine (DTIC)

Each drug attacks cancer cells in a slightly different way.

Using several drugs together can help target lymphoma cells at different stages of their growth and division.

Your exact treatment plan, the number of cycles you receive and whether your treatment changes during the course will depend on your individual diagnosis and the treatment plan recommended by your haematology or oncology team.

Does ABVD chemotherapy cause hair loss?

Yes. Hair loss is a common side effect of ABVD chemotherapy.

Some people experience thinning, while others may lose most or all of the hair on their scalp. Eyebrows, eyelashes and body hair can also be affected.

Hair loss often begins after the first or second treatment, although everyone’s experience is different.

Among the four drugs within ABVD, doxorubicin is particularly associated with chemotherapy-related hair loss.

Chemotherapy drugs work by attacking rapidly dividing cells. Cancer cells divide quickly, which is why chemotherapy can be effective against them.

However, cells within your hair follicles also divide rapidly. Chemotherapy can therefore damage these cells at the same time, causing the hair to weaken and fall out.

The amount of hair you lose can depend on factors including the chemotherapy drugs and doses you receive and your individual response to treatment.

For most people, chemotherapy-related hair loss is temporary and hair begins to grow back after treatment has finished.

Can I use a cold cap during ABVD chemotherapy?

This is where ABVD is different from many of the chemotherapy regimens discussed on the Penguin Cold Caps website.

Scalp cooling is generally not recommended for people receiving ABVD for Hodgkin lymphoma.

The reason isn’t simply that ABVD contains chemotherapy drugs that can cause significant hair loss. It is because Hodgkin lymphoma is a blood cancer, and reducing blood flow and chemotherapy exposure within the scalp may theoretically allow cancer cells present there to receive less treatment.

Your medical team should always make the final decision about whether scalp cooling is appropriate for you.

Why isn’t cold capping recommended for lymphoma?

To understand the concern, it helps to understand how scalp cooling works.

Cold capping reduces the temperature of the scalp before, during and after chemotherapy.

Cooling causes the small blood vessels within the scalp to narrow, a process called vasoconstriction. This reduces blood flow to the scalp and can reduce the amount of chemotherapy reaching the hair follicles.

Cooling also slows activity within the hair follicles, making them less susceptible to damage from chemotherapy.

For many people receiving suitable chemotherapy regimens, these effects can help reduce chemotherapy-related hair loss.

However, the very mechanism that helps protect the hair follicles is the reason scalp cooling isn’t normally recommended for people with lymphoma.

With a blood cancer, there is a possibility that cancerous cells could be present within blood vessels in the scalp.

Because scalp cooling intentionally reduces the amount of chemotherapy reaching the scalp, there is a theoretical risk that these cancer cells might receive less chemotherapy treatment.

For that reason, major cancer organisations recommend against scalp cooling for people with lymphoma and other blood cancers.

Your cancer treatment must always take priority over preventing hair loss.

Is doxorubicin the reason I can’t cold cap?

Not necessarily, and this is an important distinction.

Doxorubicin itself does not automatically mean that you cannot use scalp cooling.

Doxorubicin, sometimes referred to by its brand name Adriamycin®, is used in chemotherapy regimens for several different types of cancer.
It is a drug strongly associated with hair loss, which means people receiving doxorubicin may understandably be particularly interested in scalp cooling.

When doxorubicin is used to treat a non-haematological cancer, scalp cooling may be suitable, depending on the complete chemotherapy regimen, dose and individual patient’s circumstances.

Penguin Cold Caps’ information on chemotherapy, for example, includes Adriamycin (doxorubicin) among the chemotherapy drugs patients may encounter.

The important question is therefore not simply: “Am I having doxorubicin?”

It’s: “What cancer am I being treated for, what chemotherapy regimen am I receiving, and is scalp cooling medically suitable for me?”

If you are receiving doxorubicin as part of a treatment for a cancer other than lymphoma or another blood cancer, speak to your oncology team about whether scalp cooling could be an option.

Why does the type of cancer matter when deciding whether to cold cap?

Cold capping isn’t suitable for every cancer or every chemotherapy regimen.

When determining whether scalp cooling is appropriate, your medical team will consider factors including:

• the type of cancer you have
• the chemotherapy drugs you are receiving
• how your chemotherapy is administered
• your individual medical circumstances
• whether there is any reason reducing blood flow to your scalp could be inappropriate.

This is why two people receiving the same chemotherapy drug may receive different advice about cold capping.

One person receiving doxorubicin as part of treatment for a solid tumour may potentially be able to cold cap, while someone receiving doxorubicin within ABVD for Hodgkin lymphoma would normally be advised not to.

What other side effects can ABVD chemotherapy cause?

Everyone responds to chemotherapy differently. Some people experience relatively manageable symptoms, while others find particular stages of treatment more difficult.

Your medical team will monitor you closely and can often prescribe medicines or recommend measures to help manage side effects.

Alongside hair loss, possible side effects of ABVD can include:

• Fatigue
  Feeling tired is common during chemotherapy and may become more noticeable as treatment progresses. Try to pace yourself and allow time to recover after treatment. Your medical team can also check whether other factors, such as anaemia, are contributing to fatigue.
• Increased risk of infection
  Chemotherapy can temporarily reduce the number of white blood cells that help your body fight infection. Your treatment team will explain which symptoms require urgent medical attention and who you should contact if you feel unwell or develop a temperature during treatment.
• Nausea and vomiting
  ABVD can cause nausea, although anti-sickness medicines can help control it. Tell your medical team if the medication you’ve been prescribed isn’t controlling your symptoms, as alternative medicines may be available.
• Mouth soreness
  Chemotherapy can cause a sore mouth or mouth ulcers. Following the mouth-care advice provided by your treatment team can help reduce discomfort and lower the risk of infection.
• Changes in taste and appetite
  Food may taste different during chemotherapy and your appetite can change. These effects are normally temporary and improve after treatment.
• Effects on your nerves
  Some chemotherapy drugs can cause tingling, numbness or other changes in sensation, particularly in the hands and feet.
• Effects associated with bleomycin
  Bleomycin can sometimes affect the lungs, which is why your treatment team may monitor your breathing and lung function during treatment. Always report new breathlessness, coughing or breathing difficulties to your medical team.

This is not a complete list of ABVD side effects. Your haematology or oncology team will explain the risks associated with your individual treatment and what you should do if you develop symptoms.

What can I do about hair loss if I can’t cold cap?

Being told that cold capping isn’t recommended can be particularly disappointing if keeping your hair was important to you.

Hair loss can affect identity, confidence and privacy as well as appearance, and there is no right or wrong way to feel about it.

Although scalp cooling may not be appropriate during treatment for Hodgkin lymphoma, there are other things that can help you prepare for and manage hair loss.

• Consider a wig before your hair starts falling out
  If you would like a wig that closely matches your existing hair, choosing one before significant shedding begins can make matching the colour, texture and style easier. Your hospital may be able to recommend specialist wig services or explain whether financial help is available.
• Try scarves, hats or turbans
  Many people alternate between wigs and different types of headwear. Soft scarves, hats and turbans can also help keep your head warm after losing your hair.
• Consider cutting your hair shorter
  Some people find that having their hair cut shorter before treatment makes subsequent thinning and hair loss feel more manageable. Others prefer not to make any changes until they know how their hair responds. Both approaches are completely valid.
• Look after your scalp
  Your scalp can become more sensitive once your hair begins to thin. Use gentle products and protect exposed skin from cold weather and strong sunlight. Your treatment team can advise you on suitable scalp care while undergoing chemotherapy.

Remember that although losing your hair can be upsetting, hair loss caused by ABVD is normally temporary.

Your hair usually begins to grow again after chemotherapy has finished. Initially, it may look or feel different from your previous hair and can sometimes grow back with a different texture or colour.

What if I’m having doxorubicin for another cancer?

If you found this article because you’ve been told you’ll receive doxorubicin or Adriamycin, but you don’t have lymphoma or another blood cancer, the advice may be different.

Don’t assume that receiving doxorubicin means you cannot cold cap.

Scalp cooling is used alongside some chemotherapy regimens containing drugs associated with significant hair loss, including doxorubicin.

Whether it is appropriate for you depends on your cancer diagnosis, complete chemotherapy regimen and individual medical circumstances.

Speak to your oncology team about scalp cooling before your first chemotherapy treatment.

If your medical team confirms that cold capping is suitable, your local Penguin Cold Caps representative can then explain how the system works and what’s involved before, during and after each treatment.