Info on MOPP

[AMD45]

I just got back from my primary doc and he was telling me about a letter he just got from my onc telling him what chemo he plans to do next -- I couldn't get him to give ME that info. Anyway, he's talking about doing MOPP. I know there are folks on the board who've had MOPP and I'd really appreciate any info you can give me about it. Thanks.

[BerniFriesen]

Hi Anne-Marie:

I may be wrong, but aren't most of the MOPPets on the other side of the board? Isn't it a common treatment for the Non-Hodge Podgers?

I have only just gotten back from the UK, and so may be suffering from jet-lag in answering this.

Something in the back of my brain tells me that MOPP might also be the main German treatment for Hodge Podge though.

Ignore me - spouse-related chemo brain nonsense.

[roswelldeb]

I'm thinking MOPP used to be standard HD treatment -- before the days of ABVD. I'll be there are some old-timers who had MOPP -- I think there is an ACOR list of long-term survivors (I've seen it referenced on another list I belong to). They could probably tell you more about it. My recollection is that the MOPP had more long-term side-effects than ABVD, so that is why they use ABVD as the standard now.

When I was first diagnosed, the students at the middle school where I had been teaching held a big fundraiser and I got to go shave the heads of two of the 8th graders. Talk about a tribute!! LOL Anyway, the newspaper did a story on it and I got calls from several local people who had either gone through HD treatment or had relatives who did, and they were calling to encourage me. One of the men I remember telling me he had MOPP (he referred to the mustard gas and told stories!), and that was like 20-something years ago and was doing fine. I can't remember his name for the life of me, but I do remember he had MOPP. I'm not sure what that has to do with your question, but it brought back this memory, and I thought I'd share ...

[bbyblueiii]

Steve (BioProf) was treated with MOPP.....

[squeek]

I was just going to say that I haven't seen anyone on the board recently treated with MOPP, but some of the old timers were (a lot who don't post anymore).

You may want to try the LLS board?!? Just a thought.

[AMD45]

Colin, welcome back to this side of the pond!

I was thinking it was either one of the early HD treatments or used more for non-HD as well. The only thing I really know about it is that it's a nasty chemo. That might be hard for me after having gone through the Gemzar/Cisplat combo and having basically no bad affects (i.e. nausea etc.). I'm pretty sure the hair falls out with MOPP but I'll tell you, now that it's starting to get hot I'd be thrilled to lose my hair!

[cougarguy]

Hi Anne-Marie,

I didn't have MOPP, but I did have a protocol which was very similar to MOPP/ABV, of which I assume the MOPP drugs would be the same as just MOPP on its own. This is the protocol I had most recently:

http://www.bccancer.bc.ca/HPI/Chemot.../lycvppabo.htm

As best as we could figure out when we looked at all of the drugs, the only difference between this protocol and MOPP/ABV was that the Mustargen (M) in the MOPP was replaced by Cyclophosphamide (C) in the CVPP. The rest of the drugs were the same and they were Vincristine, which is the V in the CVPP (also known as Oncovin which would be the O in MOPP), Procarbazine and Prednisone. These last 2 would be the P's in both protocols.

From what I gather, the BC Cancer Agency substituted Cyclophosphamide for the Mustargen because it was less toxic, although I believe they are both similar drugs in the sense that they are both alkylating agents.

The Cyclophosphamide was a given with an IV, the Vincristine was a push and the Procarbazine and Prednisone were pills that had to be taken orally. The IV and push drugs were given on Day 1 and the Procarbazine was taken on days 1-7 and the Prednisone was taken on days 1-14. I don't know if this is similar to MOPP because I also had the ABO drugs on day 8 and that may change how the others are administered.

In regards to the drugs themselves, I found that the Cyclophosphamide and the Vincristine was okay to tolerate as long as I took my anti-nausea drugs. I absolutely HATED the Prednisone and its side effects. I had weight gain, bad muscle aches when going off of it (I didn't get tapered off of it . . . it just stopped on day 14) and an absolutely terrible taste in my mouth on a constant basis. In short, I feel bad for anyone that has to take that drug. I also has some weird side effects from the Procarbazine. I had mood swings (could've been the Prednisone as well), flushed skin and I also had trouble sleeping. When I did sleep I sometimes had weird dreams and nightmares, not fun The other thing to watch with Procarbazine is that it is an MAOI drug so you really have to watch your diet. You can't eat certain things (certain cheese, cured meats, and lots of other common stuff) as it can result in dangerously high blood pressure and other side effects. I'm not up on the the reasons as to why this is, but there is lots of stuff on the Internet if you do a search on MAOI drugs. Your doc should also go over all of this with you.

It's hard for me to say much more since I did have the other drugs as well, but I can tell you that from everything I researched, MOPP is considered a "heavier" protocol than ABVD with more toxicity and greater side effects. I did wear down allot towards the end of my treatments and my energy was WAY down but I think I came out okay at the end

Hope this helps and feel free to give me shout if you think there is anything else that I can help with or if you have any questions.

Take care,

Neil

p.s. I should also add that the BC Cancer Agency website (www.bccancer.bc.ca) has lots of good info on the various drugs, the side effects, other stuff, etc. Well worth a look as itr may be able to help you with some of the questions you may have. Here is the link to those particular spots:

http://www.bccancer.bc.ca/HPI/DrugDatabase/default.htm

[AMD45]

My biggest concern is the Prednesone -- I HATE it. I've told my onc that I want to hold off taking Pred as long as possible. He said he would do his best but if he's talking MOPP, Pred is part of it. I'm also a little bugged that when I asked him about what treatment he would do next he wouldn't tell me but he told my GP. I guess I'll just have to wait and see. I'm having a CT scan on May 1 and depending on the results, I may or may not have to start treatment now.

[Moondoggie22]

I just found out that I'm probably going be going on MOPP too - small little chemo world. My doc's rundown sounds pretty much like what CougarGuy ran throough above. In strength related to other chemos I've had, he said this would be the "easiest" of the chemos we could go to next and that it shouldn't be anything compared to the ifosfamide/navelbine/gemzar I just had, especially since the ifos dose was twice what you usually get in the ICE protocol. He said he wasn't worried about giving me strong chemo (that badass factor, you know), but that the other strong chemos he could give were in the same family as the ifos, so he's thinking MOPP will be different enough that it might do something for me. I'll probably be starting on it next week, so I'll let you know how I'm doing, since I'll have a couple of days head start on you

[BioProf]

Anne-Marie,
Sorry for not posting sooner, but I'm still having cookie issues.

I had MOPP-ABV rather than straight MOPP. I got the iv portions (M&O) on day one and took the pills (P&P) on days 1-14. Rather than getting more M&O on day 8 I got ABV instead. Days 15-28 were no drugs at all. Nevertheless I can tell you my experience.

First of all, it worked! I've had clean scans for almost 7 years now.

Side effects were similar to ABV, although somewhat more pronounced for me. The Mustard is nasty stuff and can destroy your veins. I got the first infusion without a port and I couldn't straighten that arm for a month. The O (vinblastine?) is similar to vincristine- both cause peripheral neuropathy and constipation. I had typical nausea and fatigue as well, but zofran, kytril, decadron and compazine managed the nausea fine.

One of the P's is for prednisone. The dose was very high- 150 mg / day for 14 days followed by 14 days of nothing. So the mania and all the other effects were not fun. The other P is procarbazine. I think it's this one that reacts with a chemical called hydroxytryptohan that is found in ceratin foods. So MOPP requires some dietary changes like no caffeine, chocolate or grapefruit. The list is longer, I just remember the no caffeine rule. MOPP also has a higher risk of causing inferility than ABVD.

Finally, I don't know if it was me, the MOPP, or not getting neupogen every cycle, but I ended up with febrile neutropenia 3 out of 6 cycles. Like clockwork, my WBC counts would bottom out around day 16, usually well below 500, and I would spike fevers over 101.5. This required several days in isolation with vancomycin and benadryl (I react badly to the vancomycin) to clear the infection. I only ever got neupogen at this point, never earlier when it might have prevented this. I think/hope practices have changed regarding this.

Hope you're doing well.

Steve