What is CMP (Cyclophosphamide, Methotrexate, and Prednisone)?
CMP is a chemotherapy regimen consisting of cyclophosphamide, methotrexate, and prednisone used in the treatment of certain hematologic malignancies, particularly non-Hodgkin's lymphomas.
Components and Mechanism
CMP combines three medications with different mechanisms of action:
- Cyclophosphamide: An alkylating agent that damages DNA by forming cross-links between DNA strands, preventing cell division
- Methotrexate: An antimetabolite that inhibits dihydrofolate reductase, interfering with DNA synthesis and cell replication
- Prednisone: A corticosteroid with anti-inflammatory and immunosuppressive properties that can induce apoptosis in lymphoid cells
Clinical Applications
CMP has been used as part of treatment regimens for:
- Non-Hodgkin's lymphomas, particularly diffuse histology types 1
- As a component of more complex regimens for lymphoid malignancies
- Has been used historically in breast cancer treatment protocols 2
Variations and Related Regimens
CMP is often incorporated into more comprehensive regimens:
- CMFVP: CMP plus vincristine and 5-fluorouracil, used historically in breast cancer 2
- COPADM: Cyclophosphamide, vincristine, prednisone, doxorubicin, and high-dose methotrexate, used in lymphoblastic lymphoma 1
- COP: Cyclophosphamide, vincristine, and prednisone, used as cytoreductive therapy in lymphomas 1
Administration
The administration schedule varies based on the specific protocol and disease being treated. In some protocols:
- Cyclophosphamide may be given orally daily or IV in cycles
- Methotrexate may be administered weekly, either orally or IV
- Prednisone is typically given orally daily or in pulses
Efficacy and Outcomes
Historical data shows that CMP has demonstrated efficacy in certain malignancies, but modern treatment protocols have evolved to include more targeted agents:
- In non-Hodgkin's lymphoma, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) has largely replaced CMP-based regimens 1
- For aggressive lymphomas, the NCCN guidelines note that "CHOP is not adequate therapy" for certain subtypes like Burkitt lymphoma 1
- More intensive regimens like hyper-CVAD or dose-adjusted EPOCH are now preferred for many lymphoid malignancies 1
Toxicity and Side Effects
Common toxicities associated with CMP components include:
- Myelosuppression (neutropenia, thrombocytopenia, anemia)
- Nausea and vomiting
- Increased risk of infection
- Hepatotoxicity (particularly with methotrexate)
- Hemorrhagic cystitis (with cyclophosphamide)
- Corticosteroid-related effects (hyperglycemia, mood changes, insomnia)
Current Status in Treatment Paradigms
While CMP was historically important, current NCCN guidelines for lymphomas and leukemias generally recommend more intensive or targeted regimens. For example:
- In B-cell lymphomas, rituximab-containing regimens are now standard 1
- In Philadelphia chromosome-positive ALL, tyrosine kinase inhibitors are incorporated 1
- In T-cell ALL, regimens may include nelarabine 1
The evolution of therapy has moved toward more effective combinations with improved survival outcomes and, in some cases, more manageable toxicity profiles.