Hodgkin's Chemotherapy - MOPP

In 1964, researchers at the National Cancer Institute developed the first combination chemotherapy that cured a number of patients who had relapsed following a standard radiation therapy regimen. This drug combination was called MOPP and was, for a long time, the standard treatment for Hodgkin's disease:

chemo drugs
photo by Bill Branson, NCI

MOPP has been mostly replaced by another combination chemotherapy called ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine), which is now the standard chemotherapy regimen for Hodgkin’s disease in the United States.

However, MOPP may be used if there are lung or heart conditions present or allergies to any of the medications in the ABVD combination. Additionally, 30% to 40% of people will relapse after treatment with ABVD, which will require ‘salvage’ treatment with MOPP (American Cancer Society, 2009).

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The amount of each medication, the duration of chemotherapy, and the addition of radiation therapy is determined by a number of prognostic markers, which includes your body size, your overall health status, the presence of any other medical conditions, and your response to treatment. The usually MOPP chemotherapy regimen is once a week in 4-6 week cycles. While radiation therapy is not always used as a treatment, if used, “intensive field” radiation closely targets the cancer area while avoiding damage to healthy tissues.

Medication Information

It is important to read all information on each drug and discuss your treatment options with your doctor and other members of the health care team. Ask questions about any aspect of your experience that is not clear to you. Following are brief overviews for each medication, the possible side effects, and any other special information you need to know. See each medication page for more in-depth information about each drug.

Mustargen

Mustargen is used to kill cancer cells and is administered through an IV line. You may experience pain or burning while the medication is infusing. Unless you are instructed otherwise, drink plenty of fluids to avoid the potential build up of uric acid in your blood and urine. Avoid all foods containing turmeric, which can increase the effects of Mustargen.

Mustargen side effects are nausea, vomiting, diarrhea, headache, loss of appetite, drowsiness, weakness, confusion, or a metallic taste in mouth.

Vincristine

Vincristine is another medication used to kill cancer cells, and is also administered via IV. You may experience pain or burning while the medication is infusing. Unless you are instructed otherwise, drink plenty of fluids to avoid potential kidney damage from the medication.

Vincristine side effects are nausea and vomiting, diarrhea, weight loss, stomach and abdominal pain or cramps, mouth sores, dizziness or headache. Vincristine slows intestinal movement and causes constipation; however you will need to avoid taking any bulk-forming laxatives. Vincristine affects muscle and nerve function, and this side effect may take a long time to go away after the treatment is completed. Notify your doctor immediately if you experience any trouble breathing.

Notify the medical staff immediately if you experience chills or increased urination while you are receiving the chemotherapy. Both Mustargen and Vincristine can cause severe skin and tissue damage if the medication leaks into the tissues around the IV site; notify the medical staff immediately if you experience pain, burning or notice red streaks surrounding the IV site.

Procarbazine

Procarbazine is an oral medication used to kill cancer cells, and has many drug and food interactions which can result in very high and dangerous blood pressure. You will need to consult with your doctor or dietician about foods containing tyramine to avoid this reaction. It is important to closely follow dosage instructions.

Procarbazine side effects are changes in skin color (darkening), nausea and vomiting, loss of appetite, constipation, dry mouth, drowsiness, dizziness, headache, trouble sleeping, difficulty swallowing and joint and muscle pain. Avoid alcohol, which can cause headaches, drowsiness, sweating, and difficulty breathing; smoking, due to an increased risk of developing lung cancer; and the sun. You will need to wear protective clothing and sunscreen when you are outside.

Prednisone

Prednisone is an oral steroid used to decrease your body’s immune system response to prevent swelling and allergic reactions. It is important to closely follow dosage instructions.

Notify your doctor immediately if you develop mental or mood changes, vision changes, swelling of your face, or swelling of your feet and ankles. Prednisone should not be taken with Proleukin (aldesleukin), another cancer treatment drug, or Tysabri (natalizumab), a medication used to treat MS (multiple sclerosis) and Crohn’s disease.

Additional Medications

Your doctor will also prescribe additional medications to help prevent nausea during and after the chemotherapy. Zofran (ondansetron HCL), Kytril (granisetron), Zantac (ranitidine HCL) are taken both before treatment and after treatment.

Additional Side Effects

You may become dehydrated from nausea, vomiting and diarrhea. Notify your doctor immediately if you develop decreased urine output, dry mouth or increase in thirst, absence of tears, are feeling dizzy or lightheaded, or notice that your skin is pale and wrinkled. You will also need to notify your doctor if you vomit shortly after taking any of your oral medications.

You will experience temporary hair loss from the chemotherapy; your hair will regrow once your treatments are completed. You may want to consider wearing head coverings or wigs, especially when outside in the sun.

To help avoid nausea and vomiting, do not eat before your treatments. Take any medications prescribed to prevent nausea 1-2 hours prior to your treatment. Eat small frequent meals that are high in protein. You will also want to maintain good oral hygiene, using either a soft toothbrush or toothette (a sponge on a stick). Limit your physical activity to avoid over-tiring, and avoid driving if you are affected by dizziness.

Another possible side effect of chemotherapy is low white blood cells (neutropenia), which can affect how well you are able to fight off common infections. White blood cell counts can be increased with the use of growth factors called Granulocyte Colony-Stimulating Factor (G-CSF or CM-CSF) or Neupogen (R). Antibiotics may also be prescribed as a preventative measure, but are usually only given when you present with signs of infection. Notify your doctor immediately if you develop chills, fever, or sore throat.

If radiation therapy is also used, your red blood cell counts may also be reduced. In this event, you may be prescribed erythropoietin (EPO) to stimulate your body to manufacture more red blood cells.

Long-term Effects

MOPP is no longer the first choice for Hodgkin’s disease treatment because of the large number of adverse effects and the possible long-term risk for the development of another cancer. In the first 20 years after treatment, the risk of a second cancer is more than 20%. The risk of developing another cancer after Hodgkin’s disease treatment is also related to the patient's age when they were treated. The risk is higher for people who were over 40 years old when they were initially treated. The risk for the development of a second cancer also increases as the amount of chemotherapy increases (American Cancer Society, 2009).

A loss of fertility is another long-term effect of chemotherapy and radiation therapy. Men treated with Mustargen lose their ability to produce sperm. Women may stop ovulating and menstruating, resulting in premature menopause. To help you identify available sperm or egg banking options, discuss any fertility concerns you may have with your doctor prior to beginning treatment.

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