aVincristine dose capped at 2 mg.

aVincristine dose capped at 2 mg.

peak around the fifth year, and were associated with an extremely poor prognosis, with a median survival of 6 months.49 Although the risk of leukemia was mostly attributed to concomitant radiation, patients with MOPP therapy alone were at increased risk of leukemic transformation.49'50

MOPP derivatives were introduced in the mid 1970s with the goal of similar efficacy with less toxicity. A prospective randomized trial by the Cancer and Leukemia Group B (CALGB) examined a new combination, BOPP (BCNU (carmustine), vincristine, procar-bazine, and prednisone), derived from substitution of BCNU for nitrogen mustard in the MOPP regimen. BOPP was compared to MOPP and to 2 three-drug regimens, derived by removing the procarbazine in BOPP (BOP) or removing the alkylating agent (OPP). The four-drug programs resulted in significantly higher frequency of complete remissions (BOPP 67%, MOPP 63%) than the three-drug regimens (BOP 40%, OPP 42%), and a significantly longer duration of remission and survival. In addition, BOPP had less toxicity.51 Bakemeier et al. prospectively compared BCVPP (carmustine, cyclophosphamide, vin-blastine, procarbazine, and prednisone) to MOPP. Two hundred ninety-three patients were evaluable in the induction phase of this study. The complete remission rates of BCVPP and MOPP were similar. The duration of complete remissions for previously untreated patients given BCVPP was significantly longer than that for previously untreated patients given MOPP (P = 0.02). Although hematologic toxicities were similar, BCVPP caused less gastrointestinal (P = 0.0001) and neurological toxicity (P = 0.01) than MOPP. More importantly, previously untreated patients achieving complete remission with BCVPP had a better OS than those receiving MOPP (P = 0.03).52

In other studies, alkylating agents such as cyclophosphamide or chlorambucil were used instead of the nitrogen mustard, resulting in similar efficacy but less treatment-related leukemia.5354

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