Defense & Barriers 2: Canine Lymphoma & Leukemia

Question 1

SIGNALMENT for LYMPHOMA…
age?
3 PREDISPOSED breeds?
2 breeds at LOWER RISK?

Answer 1

age = 6-9 YEARS OLD

3 at-risk breeds?
1. Boxers
2. Goldens
3. German Shepherds

2 lower risk?
1. DACHCHUNDS
2. POMS

Question 2

PRESENTATION of lymphoma…
MAJORITY present with what? +4 locations, including a combo for ADVANCED dz
5 less common forms?

Answer 2

MAJORITY develop MULTICENTRIC lymphoma…
1. LNs
2. Liver
3. Spleen
4. BONE MARROW/PERIPHERAL BLOOD IN ADVANCED DZ

Less common forms?
1. GI
2. Hepatosplenic
3. Mediastinal
4. Cutaneous
5. CNS

Question 3

5 COMMON LNs that should be PALPATED in dogs?

Answer 3

1. popliteal
2. prescapular
3. submandibular
4. inguinal
5. axillary

Question 4

MULTICENTRIC lymphoma…
MOST COMMON CLINICAL SIGN?
usually discovered as an ____ finding
often has ____ clinical signs
ADVANCED dz? (MAIN thing +8, but don’t have to list all)

Answer 4

MOST COMMON CLINICAL SIGN = PERIPHERAL LYMPHADENOPATHY

usually discovered as an INCIDENTAL finding

often has NO clinical signs

but in ADVANCED DZ, CAN HAVE NON-SPECIFIC SIGNS…
1. Weakness
2. Exercise intolerance
3. Weight loss
4. Anorexia
5. V+
6. D+
7. PU/PD
8. Uveitis

Question 5

GI lymphoma…
1. LN enlargement?
2. clinical signs? (3 listed)
3. 3 other organs that can be involved?

Answer 5

1. NO PERIPHERAL LYMPHADENOPATHY
2. NONSPECIFIC GI signs  V+, D+, weight loss
3. MESENTERIC LNs, SPLEEN & LIVER can be involved

Question 6

clinical signs of HEMATOSPLENIC lymphoma? (main + 2)

Answer 6

NONSPECIFIC SIGNS = lethargy, decreased appetite

Question 7

MEDIASTINAL lymphoma
1. SEVERITY of signs are associated with…
2. what KINDS of signs are most prevalent?
3. disease is often ____ cell associated & this causes ____

Answer 7

1. SEVERITY of signs associated with EXTENT OF DZ
2. RESPIRATORY signs
3. Often T cell associated and this causes PU/PD

Question 8

CUTANEOUS lymphoma…
1. 2 classifications?
2. 3 lesions & location?
3. skin irritation term?

Answer 8

1. Either GENERALIZED or MULTIFOCAL
2. Nodules, plaques, ulcers between DIGITS
   3.ERYTHMEMIC DERMATITIS

Question 9

CNS lymphoma…
1. 2 classifications?
2. 3 clinical signs?

Answer 9

1. MULTIFOCAL or SOLITARY involvement
2. Seizures, paralysis, paresis

Question 10

4 goals of STAGING lymphoma?

Answer 10

1. to DETERMINE EXTENT OF DZ and ORGAN INVOLVEMENT via DIAGNOSTIC TESTS
2. Identify SECONDARY medical conditions
3. Assess RESPONSE TO THERAPY
4. PROGNOSTIC significance

Question 11

STAGING/WORK-UP of lymphoma BASICS…
1. 3 things usually done?
2. cytology of..
3. IDEALLY, try to…

Answer 11

1. PE, B/W & UA USUALLY INDICATED!
2. Cytology of ENLARGED LNs!
3. IDEALLY BIOPSY but NOT ALWAYS DONE

Question 12

NAME of this syndrome?
= definition & what DZ usually associated
causes swelling of what 3 regions?

Answer 12

PRECAVAL SYNDROME

= COMPRESSION or INVASION of CRANIAL VENA CAVA from ENLARGED LNs in CHEST CAVITY usually from LYMPHOMA

causes SWELLING OF HEAD, NECK or THORACIC LIMBS

Question 13

5 PE changes associated with LYMPHOMA?

Answer 13

1. Enlarged peripheral LNs
2. Hepato-splenomegaly
3. Ocular changes
4. Skin changes
5. Dull lung sounds

Question 14

what is the MOST COMMON LYMPHOMA-RELATED HEMATOLOGIC ABNORMALITY in LYMPHOMA?

Answer 14

ANEMIA

Question 15

what hematologic finding is common in STAGE V LYMPHOMA?

Answer 15

CIRCULATING LYMPHOBLASTS

Question 16

what ELECTROLYTE can be affected by LYMPHOMA?
what’s the cause in LYMPHOMA?
what OTHER DZ can cause this?

Answer 16

HYPERCALCEMIA (~15%)

in LYMPHOMA…
–> PARAENOPLASTIC SYNDROME where PTHrP is PRODUCED

OTHER DZ = ANAL SAC CARCINOMA

Question 17

goal of performing UA if we suspect LYMPHOMA?

Answer 17

= ASSESS RENAL FUNCTION & rule out UTI especially if considering CHEMO

Question 18

what finding do we expect on THORACIC RADS for LYMPHOMA?

Answer 18

MILIARY DIFFUSE

Question 19

CYTOLOGY for LYMPHOMA…
1. is FNA a good tool?
2. what size needle for FNA?
3. FNA technique?
4. what 2 reasons do we have to perform HISTOPATH?

Answer 19

1. FNA IS GOOD!
2. 22-gauge needle
3. WOOD-PECKER –> REMOVE NEEDLE FROM SYRINGE
4. HISTOPATH if…
   –> DEFINITIVE DIAGNOSIS wanted
   –> UNSURE AFTER CYTOLOGY

Question 20

WHAT TYPE OF LYMPHOMA?

Answer 20

MEDIASTINAL

Question 21

ABDOMINAL US findings on LYMPHOMA? (2)

Answer 21

1. ENLARGED LIVER, SPLEEN, ABDOMINAL LNs
2. Spleen looks like “SWISS CHEESE”

Question 22

_____ CELL LYMPHOMA PROGNOSIS > ___ CELL LYMPHOMA PROGNOSIS

Answer 22

B CELL LYMPHOMA PROGNOSIS > T CELL LYMPHOMA PROGNOSIS

Question 23

IMMUNOPHENOTYPING…
why is it important for LYMPHOMA?
what METHOD is used?
how long does it take to get results back?
if you’re sending off an FNA, WHAT DO YOU NEED TO SHIP IT IN TO KEEP CELLS FROM DYING?

Answer 23

IMPORTANT BC B CELL PROGNOSIS > T CELL

FLOW CYTOMETRY used!

results in 3-5 days

PUT FNA IN SALINE

Question 24

5 stages of WHO MULTICENTRIC LYMPHOMA

Answer 24

Stage I = SINGLE NODE or SINGLE LYMPHOID ORGAN, EXTREMELY RARE

Stage II = ENLARGED REGIONAL NODES either CRANIAL or CAUDAL to DIAPHRAGM

Stage III = GENERALIZED LN INVOLVEMENT/LYMPHADENOPATHY

Stage IV = LIVER AND/OR SPLEEN INVOLVEMENT

Stage V = BLOOD/BONE MARROW INVOLVEMENT and/or ANY OTHER ORGAN INVOLVEMENT

Question 25

2 BIG determinants of treatment for LYMPHOMA?

Answer 25

1. OVERALL PHYSIOLOGIC STATUS OF PATIENT 2. Financial & time commitment of client --> 19-week protocol --> 6K

Question 26

3 treatment options for LYMPHOMA? + WHAT'S THE TREATMENT OF CHOICE?

Answer 26

1. NO TREATMENT = MST 4-6 weeks 2.PREDNISONE ALONE --> Lymphoma is susceptible but CAN THEN QUICKLY DEVELOP RESISTANCE --> MST = ~2 months bc then resistance forms --> If RESISTANCE TO PREDNISONE FORMS, CAUSES RESISTANCE TO CHEMOTHERAPY 3. CHEMOTHERAPY --> This is the TREATMENT OF CHOICE

Question 27

CHOP protocol for CHEMOTHERAPY? (4 drugs) single-agent chemotherapy? (2 types, how often to give)

Answer 27

CHOP protocol? 1. CYCLOPHOSPHAMIDE 2. DOXORUBICIN 3. VINCRISTINE 4. PREDNISONE SINGLE-AGENT 1. DOXORUBICIN 2. TANOVEA --> Treat dogs with this every 3 weeks for 5 treatments, THEN STOP

Question 28

PROGNOSIS for LYMPHOMA.. IF TREATED WITH CHOP-BASED CHEMO... 1. remission? 2. MST for B/T cell? 3. Cure? for ABNORMAL forms of lymphoma?

Answer 28

IF TREATED WITH CHOP-BASED CHEMO… 1. REMISSION in MOST DOGS 2. MST.. --> B cell = 12-14 mos --> T cell = 6-8 mos 3. <10% are CURED ABNORMAL forms of lymphoma... --> have UNFAVORABLE PROGNOSIS (only 4-6 mos MST) --> NO CONSENSUS on how to PREDICT SURVIVAL for dogs with LSA, but there are some KNOWN prognostic factors… --> LOCATION of FZ --> SUBSTAGE (symptomatic or not?) --> Immunophenotype

Question 29

RESCUE therapy for LYMPHOMA... most dogs will ____ with ____ disease, rescue therapy aims to induce ____ ____ but it's _____ response duration?

Answer 29

most dogs will RELAPSE with PROGRESSIVE disease, rescue therapy AIMS TO INDUCE SECOND REMISSION but it's DIFFICULT Response DURATION is 1-5 months

Question 30

CANINE T CELL LYMPHOMA... = DESCRIBE what type of lymphoma this is almost all cases occur WHERE? (2) clinical signs? (2) BEST DIAGNOSTIC TEST & result? what OTHER parameter can act as a diagnostic? SURVEILLANCE? 5 indications for chemo? drug regimen? (2 drugs & timing) prognosis?

Answer 30

= INDOLENT dz process and OVERALL BETTER SURVIVAL TIMES than NORMAL T CELL LYMPHOMA Almost all cases occur... 1. in PERIPHERAL LNs 2. usually SUBMANDIUBLAR clinical signs? 1. Often NO OTHER CLINICAL SIGNS besides… 2. LYMPHOCYTOSIS if progressing to LEUKEMIC PHASE BEST diagnostic test = FLOW CYTOMETRY of the ENLARGE LN IS BEST --> RESULT = CD4+CD45-, LOSS OF CD45 ANTIGEN other parameter? --> Or PERIPHERAL BLOOD if a HIGH LYMPHOCYTOSIS PRESENT ACTIVE SURVEILLANCE with MONTHLY EXAM and BLOODWORK is indicated if PATIENT IS FEELING WELL (IF NO LYMPHOCYTOSIS), or EVERY 2 MONTHS 5 indications for CHEMO… 1. FEELING SICK 2. MULTIPLE ENLARGED LNs 3. SPLENIC involvement 4. PERIPHERAL CYTOPENIAS 5. EXCESSIVELY HGH LYMPHOCYTE COUNT drug regimen? = Can treat with CHLORAMBUCIL (chemo) and PREDNISONE for about 10-12 months Prognosis = FAVORABLE, up to 2 years