A combination of chlorambucil, vinblastine, procarbazine and prednisolone for treatment of Hodgkin's disease

Abstract

Summary.-Seventy patients with Hodgkin's disease have been treated with a combination of chlorambucil, vinblastine, procarbazine and prednisolone (ChlVPP).The complete remission rate of 75-7 % compares well with that produced by other combinations. The combination is non-toxic, easily administered and can be given safely to outpatients. Its main advantage is that it is far less upsetting to patients than combinations containing nitrogen mustard.

British National Lymphoma Investigation randomised study of MOPP (mustine, Oncovin, procarbazine, prednisolone) against LOPP (Leukeran substituted for mustine) in advanced Hodgkin's disease – long term results

“…However, MOPP and MVPP proved toxic, particularly with regard to the mustine, which caused considerable nausea and vomiting and a high incidence of local tissue reactions (particularly phlebitis). The substitution of chlorambucil (Leukeran) appeared to give equally favourable results with less toxicity (McElwain et al, 1977). Long term follow-up of the Royal Marsden Hospital data reported in this Journal confirms this early conclusion (Selby et al, 1990).…”

Modulation of the toxicity and antitumour activity of alkylating drugs by steroids

“…For example, MEL is actively transported (Redwood & Colvin, 1980) but CHL enters by passive diffusion (Hill et al, 1971). The kinetics of DNA crosslinking induced by MEL and HN2 are different (Ross et al, 1978;Brox et al, 1980): CY has a greater therapeutic effect on experimental autoimmune disease than does CHL (Gerber et al, 1977) and the replacement of HN2 by CHL in the schedule for Hodgkin's disease resulted in similar tumour-cell kill but reduced normal-tissue toxicity (McElwain et al, 1977). It appears, therefore, that although these alkylating agents kill dividing rather than resting cells (Van Putten & Lelieveld, 1971), there are subtle differences in the spectra of their normal-tissue toxicities which are enhanced by the steroid.…”

Chlvpp is as Effective as Alternating ChlvppAbod in Advanced Stage Hodgkin's Disease

“…ChlVPP chemotherapy was administered according to the the original publication by Mc Elwain et al (17): Chlorambucil 6 mg/m2 orally (maximum of 10 mg/ m2 for a few patients) and procarbazine 100 mg/m2 orally days 1-14, vinblastine 6 mg/m2 intravenously day 1 and day 8 and prednisone 45 mg orally days 1-14. Patients randomized to receive ChlVPP/ABOD received ChlVPP as described on cycles 1, 3, 5 and 7 , and ABOD on cycles 2, 4, 6 and 8.…”