C-MOPP: Results of a Forgotten Regimen for Follicular Lymphoma in the Era of Rituximab and PET.

A variety of options are available in first and second-line treatment of advanced follicular lymphoma. We report the efficacy and toxicity of an immunochemotherapy regimen, C-MOPP-R, in both upfront and salvage settings.

We retrospectively reviewed all thirty-five cases of follicular lymphoma treated with C-MOPP-R at our institution from 2000 through 2008. Excisional lymph node biopsies demonstrating follicle center cell phenotype with any follicular component were required. Patients received six planned 28-day cycles of rituximab 375mg/m² IV day 1 & 8, cyclophosphamide 650mg/m² IV day 1 & 8, uncapped vincristine 1.4mg/m² IV day 1 & 8, procarbazine 100mg/m² PO day 1-14, and prednisone 60mg/m² PO day 1-14. All patients received pegylated filgrastim day 9 and prophylactic antimicrobials. Remission was assessed with PET, bone marrow biopsy/aspirate, and clinical assessment using the Revised Response Criteria for Lymphoma in all but one patient, who had computed tomography instead of PET. Most patients received consolidation therapy on a phase II pilot study, and progression-free and overall survival will be reported in the future.

See table for baseline characteristics, response, and grade 3 & 4 toxicities. The overall response rate for de novo and relapsed patients was 100% and 76%, respectively. Seven patients did not complete six cycles of therapy, two patients due to progressive disease and five due to various toxicities at the judgment of treating physicians. Eight patients required cessation of vincristine during therapy for grade II neuropathy.

C-MOPP-R is an efficacious, tolerable immunochemotherapy regimen in de novo and relapsed follicular lymphoma. Response rates in an upfront setting are particularly high, and it represents a feasible regimen that should be considered in this disease.

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No relevant conflicts of interest to declare.