Hyper-CVAD is a chemotherapy regimen used to treat some forms of leukemia, high-grade non-Hodgkin lymphoma, and lymphoblastic leukemia.

Hyper-CVAD chemotherapy consists of two combinations of drugs given in an alternating fashion. 

The term hyper refers to the hyperfractionated nature of the chemotherapy.

CVAD’ is the acronym of the drugs used in course A: cyclophosphamide, vincristine, doxorubicin and dexamethasone. 

Course B consists of methotrexate and cytarabine.


For the treatment of serious and aggressive forms of hematological malignancy: Burkitts lymphoma, acute lymphoblastic leukemia.

Each course is given up to 4 times, with up to 8 cycles in total. Each cycle is approximately three weeks apart. 

The aim is to administer as many cycles as possible or necessary in as short a time as possible. 

The regimen is usually administered on an in-patient basis, using a continuous venous access device such as a peripherally inserted central catheter (PICC), a Hickman line, or a port-a-cath. 

The exact combination of drugs, doses, and protocols used for administration is generally determined on a facility-by-facility basis. 

Dosage is individualized, based on factors such as body weight, body surface area, and the overall health of the patient.

Course A

Cyclophosphamide (Cytoxan), an alkylating agent, Days 1, 2, and 3

Vincristine (Oncovin), a mitotic inhibitor, Days 4 and 11

Doxorubicin (Adriamycin or Rubex), an antibiotic with anti-tumour effects, Day 4

Dexamethasone (Decadron), an immunosuppressant, Days 1-4 and 11-14

Cytarabine or Ara-C (Cytosar), an antimetabolite, Day 7

Mesna a compound used to reduce the incidence of haemorrhagic cystitis. Generally given via intravenous infusion or orally at the same time as cyclophosphamide.

Methotrexate, an antimetabolite, may be given via the intrathecal route when it is necessary to get chemotherapy past the blood–brain barrier.

Course B

Methotrexate, Day 1

Leucovorin is used as a rescue agent to prevent excessive cellular damage by methotrexate.

Sodium bicarbonate is used, beginning the day before methotrexate, to produce a mild metabolic alkalosis, desirable when administering large quantities of methotrexate. 

Urine pH values will be checked to ensure alkalosis prior to the commencement of methotrexate.

Cytarabine, Days 2 and 3

The side effects:

Pancytopenia, and secondary manifestations.


Vincristine sometimes causes chemotherapy-induced peripheral neuropathy

Many versions of HYPER-CVAD exist adding additional agents such as rituximab, changing doses and schedule, and adding intrathecal therapy.

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