MOPP regimen

Nitrogen mustard is clinically used for the treatment of lymphomas and some forms of lung cancer. The major indication for mechlorethamine is Hodgkin s disease as a part of the MOPP regimen (mechlorethamine + vincristine (oncovin) + procarbazine + prednisone). The usual dose consists of 6 mg/m2 on days 1 and 8. This drug has pronounced hematological toxicity (myelo-suppression). 

The chemotherapy of advanced Hodgkin s disease is one of the best examples of successful combination chemotherapy. Combination therapy with the MOPP regimen (mechlorethamine, Oncovin [vincristine sulfate], procarbazine, prednisone), alternating with ABVD (Adriamycin [doxorubicin hydrochloride], bleomycin, vinblastine, dacarbazine), has resulted in cure rates of 50 to 60%. 

The major indication for mechlorethamine is Hodgkin s disease the drug is given in the MOPP regimen (mechlorethamine, vincristine, procarbazine, prednisone see Chapter 55). Other less reactive nitrogen mustards are now preferred for the treatment of non-Hodgkin s lymphomas, leukemias, and various solid tumors. 

Therapeutic applications Mechlorethamine is used primarily in the treatment of Hodgkin s disease as part of the MOPP regimen (Mechlorethamine, Oncovin, Prednisone, Procarbazine), and is also useful in the treatment of some solid tumors. 

Procarbazine, an antineoplastic agent (2 to 4 mg/kg/day for the first week) in combination with other antineoplastic agents (MOPP regimen—nitrogen mustard, vincristine, procarbazine, prednisone), is indicated in the treatment of stage III and IV Hodgkin s disease. Procarbazine inhibits the synthesis of protein RNA and DNA (see also Figure 15). 

Clinical use Mechlorethamine is best known for use in the MOPP regimen (see below) for Hodgkin s disease. 

Clinical use The primary use of the drug is as a component of the MOPP regimen for Hodgkin s disease. 

A. Glucocorticoids Prednisone is the most commonly used glucocorticoid in cancer chemotherapy. The steroid has applications in dmg regimens for acute and chronic lymphocytic leukemia. Hodgkin s disease (MOPP regimen), and other lymphomas. Toxicity is described in Chapter 39. 

Items 11-12 A 23-year-old man with Hodgkin s disease was treated unsuccessfully with the MOPP regimen. He subsequently underwent a successful course of therapy with the ABVD regimen. 

The cell cycle-specific drugs used in standard treatment protocols for Hodgkin s disease are bleomycin and the vinca alkaloids. Vinblastine is used in the ABVD regimen, and vincristine (Oncovin) is used in the MOPP regimen. The answer is (E). 

The anticancer drug most commonly associated with pulmonary toxicity is bleomycin. If pulmonary dysfunction with infiltration developed, the drug would be discontinued. High-dose steroids and empiric antibiotic therapy would also be indicated. Note that procarbazine (not listed), used in the MOPP regimen for Hodgkin s lymphoma, may also cause cough and pleural effusions. The answer is (A). 

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