Hyper-CVAD

Say it: HY-per C-vad

Part A: cyclophosphamide, vincristine, doxorubicin and dexamethasone. Part B: methotrexate and cytarabine

Hyper-CVAD is an intensive chemotherapy plan for adults with acute lymphoblastic leukemia (ALL) that switches back and forth between two different combinations, called Part A and Part B.

Also called: HyperCVAD, Hyper CVAD, Hyper-CVAD A and B, Hyper-CVAD plus rituximab, R-Hyper-CVAD, Hyper-CVAD with methotrexate and cytarabine

What it is

Part A and Part B use different medicines, so together they hit the leukemia from many sides and leave less chance for it to resist. Medicine is also given into the spinal fluid to stop leukemia from hiding in the brain and spine. The goal is cure. After the 8 cycles, most people move on to about 2 years of gentler maintenance treatment (often POMP), or to a stem cell transplant.

Often used for

• Acute lymphoblastic leukemia (ALL) in adults
• Philadelphia chromosome positive ALL, together with a targeted pill
• Burkitt lymphoma and some other aggressive lymphomas
• Some younger, fit adults with mantle cell lymphoma

Part A (cycles 1, 3, 5 and 7)

Cyclophosphamide with mesna, vincristine, doxorubicin and dexamethasone. Usually a hospital stay of about 4 to 5 days.

Part B (cycles 2, 4, 6 and 8)

High dose methotrexate with leucovorin rescue, then high dose cytarabine. Usually a hospital stay of about 4 to 6 days, until the methotrexate has cleared from your blood.

With rituximab

If the leukemia or lymphoma cells carry a marker called CD20, rituximab (an antibody) is often added to the first several cycles.

With a targeted pill for Philadelphia positive ALL

If the leukemia has the Philadelphia chromosome (BCR::ABL1), a daily pill such as ponatinib or dasatinib is added.

The medicines in this plan

Cyclophosphamide

Part A. Chemotherapy given through a vein every 12 hours on days 1 to 3 (6 doses in all).

Mesna

Part A. A protector medicine given with cyclophosphamide to keep the bladder from getting irritated and bleeding.

Vincristine

Part A. Chemotherapy pushed through a vein on day 4 and day 11. It can cause tingling and constipation.

Doxorubicin (Adriamycin)

Part A. A red colored chemotherapy given through a vein on day 4. It can affect the heart, so heart tests are done.

Dexamethasone

Part A. A steroid pill or IV medicine given on days 1 to 4 and 11 to 14. It kills leukemia cells directly.

Methotrexate

Part B. High dose chemotherapy dripped through a vein over about 24 hours on day 1. Also given into the spinal fluid during both parts.

Cytarabine (Ara-C)

Part B. High dose chemotherapy given through a vein every 12 hours on days 2 and 3. Also given into the spinal fluid.

Leucovorin

Part B. A rescue medicine started after methotrexate to protect your healthy cells. Taken until your methotrexate blood level is low enough.

How you get it

Hyper-CVAD is given in 8 cycles, switching between Part A and Part B, so 4 of each. Most people stay in the hospital for several days for each cycle, then go home to recover. A new cycle starts about every 3 to 4 weeks once blood counts recover, so the whole plan takes about 6 to 8 months. You will need a central line or port, and you will have spinal taps (lumbar punctures) to put chemotherapy into the spinal fluid. Your schedule may be different.

A typical cycle

Part A, days 1 to 4 (hospital)

Cyclophosphamide every 12 hours with mesna and lots of IV fluid, dexamethasone, then doxorubicin and vincristine on day 4.

Part A, days 5 to 21

Home with a white blood cell booster shot. Vincristine and more dexamethasone around day 11. Clinic visits for blood tests and transfusions while counts are low.

Part B, days 1 to 3 (hospital)

High dose methotrexate over 24 hours, then cytarabine every 12 hours on days 2 and 3. Leucovorin rescue and daily methotrexate blood levels until clear.

Part B, days 4 to 21

Home with a booster shot and steroid eye drops. Frequent blood tests and transfusions while counts are low.

Throughout

Spinal taps with chemotherapy, usually 1 or 2 in each cycle for the first several cycles.

After 8 cycles

About 2 years of maintenance (often POMP), or a stem cell transplant for some people.

Common side effects and what helps

• Very low blood counts after every cycle, with high infection risk. Wash hands often, avoid sick people, and follow food safety rules.
• Nausea and vomiting. Take anti-nausea medicines on schedule.
• Hair loss, usually starting 2 to 3 weeks after the first cycle.
• Mouth sores, especially after Part B. Rinse your mouth several times a day with a mild salt and baking soda rinse.
• Tingling in fingers and toes, jaw pain or constipation from vincristine. Use a daily stool softener if your team advises it.
• High blood sugar, mood swings, trouble sleeping and big appetite from dexamethasone. Take it in the morning with food.
• Tiredness that builds over the months. Short walks and rest both help.
• Red or sore eyes after Part B cytarabine. Use the steroid eye drops as directed.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Bleeding that will not stop, red or pink urine, or many new bruises
• No bowel movement for 3 days, or bad belly pain
• Trouble walking, new weakness, poor balance or slurred speech
• Shortness of breath, chest pain, or swelling in the legs
• Severe headache or back pain after a spinal tap
• Vomiting so much you cannot keep fluids down, or passing much less urine than usual
• Yellow skin or eyes

Good to know

• Expect a hospital stay for most cycles. Bring comfortable clothes and things to pass the time.
• A heart test (echocardiogram) is done before starting because doxorubicin can affect the heart.
• During Part B, your methotrexate blood level is checked daily, and you stay on leucovorin until it is low enough. Avoid certain medicines that slow methotrexate clearance; your team will review your list.
• In the first days of treatment, the breaking down of many leukemia cells can strain the kidneys (tumor lysis). You will get extra fluids and medicines to prevent this.
• You will take medicines to prevent bacterial, viral, fungal and pneumonia infections between cycles.
• Blood and platelet transfusions are common and expected.

At home

• Check your temperature twice a day and any time you feel unwell.
• Take your booster shots, infection prevention pills and eye drops exactly as scheduled.
• Use a soft toothbrush and rinse your mouth often.
• Eat foods with fiber and drink fluids to prevent constipation from vincristine.
• Avoid raw or undercooked meat, eggs and fish, and stay away from people who are sick.

Questions to ask

• How long will each hospital stay be?
• Will rituximab or a targeted pill be added to my plan?
• How many spinal taps will I need?
• What happens after the 8 cycles: maintenance, transplant, or something else?
• Which medicines should I avoid during Part B?

Leukemia

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.