• Lewis

Part Seventeen: IVE explained

Updated: Sep 26, 2020

IVE is a chemotherapy regime that is used to treat refractory and relapsed Hodgkin’s Lymphoma, as well as certain Non-Hodgkin’s Lymphoma.


It is administered over four days, as an in-patient within a hospital. It is often referred to as “Salvage Chemotherapy” or second-line chemotherapy.


It consists of three cytotoxic chemotherapy agents.


IVE is a chemotherapy regime that is used to treat refractory and relapsed Hodgkin’s Lymphoma, as well as certain Non-Hodgkin’s Lymphoma.


It is administered over four days, as an in-patient within a hospital. It is often referred to as “Salvage Chemotherapy” or second-line chemotherapy.


It consists of three cytotoxic chemotherapy agents.


I Ifosfamide

V VP-16 (you’ll know this as Etoposide from BEACOPP)

E Epirubicin


Supportive medicine that sits alongside the regime is equally important; it helps prevent side effects and helps the chemotherapy drugs to work more effectively. These include; 


  • Mesna (a drug to prevent your kidneys from bleeding following cyclophosphamide infusion;) 

  • Allopurinol (to prevent chemotherapy drugs breaking up in your muscles and joints, causing gout;)

  • G-CSF Injections (to help your white blood cell count recover to be able to receive more chemotherapy)

  • Ondansetron, Metoclopramide, Cyclosine, Aprepitant (anti-sickness drugs)

  • Co-trimoxazole (an anti-biotic taken three times a week, to help prevent infection.)

  • Aciclovir (a drug to prevent re-activation of virus’ such as chickenpox.)


The drugs are administered as follows;


Day One - Epirubicin as a slow injection into the Hickman line over five minutes alongside a saline drip. This is then followed by three hours of Etoposide. Mesna is then given before a 22-hour drip of Ifosfamide.


Day Two - Etoposide over three hours, followed again by 22 hours of Ifosfamdie - this time mixed with Mesna.


Day Three - Day two all over again.


Day Four - 12 hours of Mesna.


As you can see, this is quite a full-on regime with circa 96 hours of treatment. It has a depressive effect on the bone marrow, drastically reducing red blood cells, white blood cells and platelets.


IVE carries the possibility of many side effects as you can imagine. These are split into two categories short-term side effects and long-term side effects. Short term side effects are things such as hair loss, sickness and nausea, muscle aches, bone pain, risk of infection, anaemia (low red blood count,) sore eyes, breathlessness, mouth sores and neuropathy (pins and needles and/or pain in the nerves.) 


Long-term side effects are; permanent neuropathy; damage to the heart muscle; damage to the lungs; increased risk of heart disease; risk of lung disease or COPD; permanent infertility and risk of developing second malignancy, most commonly Leukemia or non-Hodgkin’s Lymphoma in around 3% of those treated.


However, it is worth noting that IVE can be very successful in relapsed and refractory Hodgkin’s Lymphoma.