regimen-monograph

MOPP

Regimen Category

ARCHIVED

Drugs Used

mechlorethamine , vinCRIStine , procarbazine , prednisone

A - Regimen Name

MOPP Regimen

Mechlorethamine-ONCOVIN® (VinCRIStine)-Procarbazine-Prednisone

Disease Site

Hematologic - Lymphoma - Hodgkin's

Intent

Curative
Palliative

Regimen Category

Archived : No longer in use and listed for reference purposes only, although the use of such a regimen may be appropriate in a situation where a Standard Regimen cannot be used for clinical reasons. Note: The Disease Site Group considers this regimen archived. It is listed for historical reference only and is no longer updated.

Rationale and Uses

Therapy for Hodgkin's Lymphoma (not as first-line)

B - Drug Regimen

mechlorethamine

(Round to nearest 0.1 mg)

6 mg /m²

Day 1 & Day 8

vinCRIStine

(Round to nearest 0.1 mg)

1.4 mg /m²

IV (max 2 mg)

Day 1 & Day 8

procarbazine

100 mg /m²

Daily for 14 days

_{(Outpatient prescription in multiples of 50mg capsules) (continued on next page)}

prednisone

50 mg /m²

PO *

Daily - for 14 days

_{(*May be given in cycles 1 & 4 ONLY)}
_{(Outpatient prescription in multiples of 5mg & 50mg tablets)}

C - Cycle Frequency

REPEAT EVERY 28 DAYS

For a Usual Total of 6 Cycles

D - Premedication and Supportive Measures

Antiemetic Regimen:

Moderate

E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.

Dosage with toxicity

Hematologic Toxicities

See Appendix 6 for general recommendations. Procarbazine should be held if myelosuppression develops; restart after recovery with a reduced dose.

G-CSF support should be considered after first episode of febrile neutropenia or delay of dose ≥ 1 week.

Platelets (x 10⁹/L)		Leukocytes (x 10⁹/L)	Dose (% of previous)
Platelets (x 10⁹/L)		Leukocytes (x 10⁹/L)	Mechlorethamine	Vincristine	Procarbazine	Prednisone
>100	and	>4	100%	100%	100%	100%
>100	and	3 to <4	75%	100%	75%	100%
>100	and	2 to <3	50%	100%	50%	100%
50 to < 100	and/or	1 to < 2	25%	50%	25%	100%
<50	and/or	<1	OMIT	OMIT	OMIT	OMIT

Neurotoxicity

Symptom	% of Vincristine usual dose
areflexia only	100 %
abnormal buttoning, writing	67 %
moderate motor neuropathy (± cranial)	Hold until recovery then reduce dose by 50%
severe motor neuropathy	Omit

Hepatic Impairment

Bilirubin (µmol/L)	% Usual Dose
1-2 x ULN	REDUCE Vincristine to 50% dose
2-4 x ULN	REDUCE Vincristine to 25% dose

Consider reduction dose of Procarbazine if hepatic function is reduced. (Suggested action)

Elevated LFTs ( > 1.5 – 5 x ULN )	REDUCE Procarbazine by 25%
If Bilirubin > 1.5 x ULN or LFTs > 5 x ULN	HOLD Procarbazine

Renal Impairment

Consider dose reduction of Procarbazine if renal function is reduced. (i.e. BUN> 14.3 mmol/L, serum creatinine> 1.5 X ULN or CrCl < 0.2 mL/sec). (Suggested action)

F - Adverse Effects

Refer to mechlorethamine, vinCRIStine, procarbazine, prednisone drug monograph(s) for additional details of adverse effects

G - Interactions

Refer to mechlorethamine, vinCRIStine, procarbazine, prednisone drug monograph(s) for additional details

H - Drug Administration and Special Precautions

Refer to mechlorethamine, vinCRIStine, procarbazine, prednisone drug monograph(s) for additional details

I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

Clinical toxicity assessment (including local toxicity, nausea and vomiting, bleeding, infection, constipation, neurotoxicity, pulmonary, hypersensitivity).
CBC before each cycle. Interim counts should be done in first cycle and repeated if dose modifications necessary.
Routine blood glucose test.
Routine pulmonary function test.
Baseline and regular liver and renal function tests (including electrolytes and magnesium), and urinalysis.
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

J - Administrative Information

Approximate Patient Visit

1 hour

K - References

Bonadonna G, Valagussa P, Santoro A. Alternating non-cross-resistant combination chemotherapy or MOPP in stage IV Hodgkin’s disease: a report of 8-year results. Ann Intern Med, 1986; 104: 739-746

Canellos GP, Anderson JR, Propert KJ, et al, Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med, 1992; 327: 1478-1484

Longo DL, Young RC, Wesley M, et al. Twenty years of MOPP therapy for Hodgkin’s disease. J Clin Oncol, 1986; 4: 1295-1306

L - Other Notes

Confirm drug coverage with other third party prescription plans.

_{^{September 2011: regimen archived}}

M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
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Last Updated: July 27, 2026

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