MOPP was first used in the 1960s.
M = Methlorethamine
O = Vincristine (also used to be called Oncovin)
P = Prednisone
P = Procarbazine
Standard therapy was 6 cycles.
Dr. Sarah Donaldson and colleagues at Stanford introduced the idea of combined modality
therapy using the MOPP backbone and low-dose RT to areas of bulky disease.
ABVD was developed as an alternative effective regime in 1970s:
- Improved survival
- Decreased long-term side effects (much less risk of second malignancy and infertility)
A = Adriamycin (doxorubicin)
B = Bleomycin
V = Vincristine
D = Dacarbazine
Published complete remission rates with MOPP, MOPP/ABVD and ABVD range from 70% to 90% for low and intermediate risk Hodgkin lymphoma.
Principles of chemotherapy in Hodgkin Lymphoma:
There are many active drugs against Hodgkin lymphoma. Each agent of the drug regimen should:
- be individually active against the tumor
- have a different mechanism of action - target different cellular or biochemical events and prevent development of resistance.
- have non-overlapping toxicities
Optimal chemotherapy treatment consists of the maximum number of active drugs with maximum dose intensity and administered as early after diagnosis as possible.
Current mainstream chemotherapy combinations are ABVD and MOPP. These drug regimens can be used alone or as alternating (MOPP/ABVD) sequences. Some studies found that MOPP/ABVD used in alternating schedule was more effective than using just one combination alone. This maximizes the effectiveness of the treatment and reduces the combined toxicities.
Timing and dose of chemotherapy are more likely to be dependant on age of patient and original tumor size/bulk. Current protocol for advanced disease calls for of low dose irradiation to involved field coupled with approximately 6 cycles of chemotherapy. However, patients with favourable outcome and findings may benefit from fewer chemotherapy cycles.