MOPP regimen, lymphomas

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 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. 

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. 

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). 

Ever since MOPP therapy was created and the efficacy confirmed, researchers tried to modify the regimen in an attempt to improve efficacy and decrease toxicity. Some MOPP variations include MVPP (vinblastine substituted for vincristine), CVPP (cyclophosphamide substituted for mechlorethamine), and ChlVPP (chlorambucil substituted for mechlorethamine, and vinblastine substituted for vincristine) were attractive alternatives to MOPP because they offered equal efficacy and differing or less severe toxicities. The various combination chemotherapy regimens appear to produce initial complete response rates in over 80% of the patients treated, and result in a 55% to 65% cure rate for advanced Hodgkin s lymphoma. 

Mechlorethamine HCl (Mustargen) was formerly used primarily in the combination chemotherapy regimen MOPP (mechlorethamine, vincristine [Oncovin], procarbazine, and prednisone) in patients with Hodgkin s disease. It is given by intravenous bolus administration in doses of 6 mg/m on days 1 and 8 of the 28-day cycles of each course of treatment. It has been largely replaced by cyclophosphamide, melphalan, and other more stable alkylating agents. It also is used topically for treatment of cutaneous T-cell lymphoma as a solution that is rapidly mixed and applied to affected areas of skin. 

Clinical use Vincristine is a component of the MOPP and COP combination dmg regimens and is used in acute leukemias, lymphomas, Wilms tumor, and choriocarcinoma. Vinblastine is a component of the ABVD regimen for Hodgkin s disease and is used for other lymphomas, neuroblastoma, testicular carcinoma, and Kaposi s sarcoma. 

Bone marrow depression, nausea, vomiting, neurotoxicity, CNS depression, dermatitis, stomatitis. PO. Well absorbed, rapidly metabolized to active drug by liver microsomes. Hodgkin s lymphoma (MOPP combination drug regimen). Potentiates sedatives, acts as a weak MAO inhibitor, acts like disulfiram in patients consuming alcohol. 

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