Defense & Barriers 2: Canine Lymphoma & Leukemia Flashcards
SIGNALMENT for LYMPHOMA…
age?
3 PREDISPOSED breeds?
2 breeds at LOWER RISK?
age = 6-9 YEARS OLD
3 at-risk breeds?
1. Boxers
2. Goldens
3. German Shepherds
2 lower risk?
1. DACHCHUNDS
2. POMS
PRESENTATION of lymphoma…
MAJORITY present with what? +4 locations, including a combo for ADVANCED dz
5 less common forms?
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
5 COMMON LNs that should be PALPATED in dogs?
- popliteal
- prescapular
- submandibular
- inguinal
- axillary
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)
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
GI lymphoma…
1. LN enlargement?
2. clinical signs? (3 listed)
3. 3 other organs that can be involved?
- NO PERIPHERAL LYMPHADENOPATHY
- NONSPECIFIC GI signs V+, D+, weight loss
- MESENTERIC LNs, SPLEEN & LIVER can be involved
clinical signs of HEMATOSPLENIC lymphoma? (main + 2)
NONSPECIFIC SIGNS = lethargy, decreased appetite
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 ____
- SEVERITY of signs associated with EXTENT OF DZ
- RESPIRATORY signs
- Often T cell associated and this causes PU/PD
CUTANEOUS lymphoma…
1. 2 classifications?
2. 3 lesions & location?
3. skin irritation term?
- Either GENERALIZED or MULTIFOCAL
- Nodules, plaques, ulcers between DIGITS
3.ERYTHMEMIC DERMATITIS
CNS lymphoma…
1. 2 classifications?
2. 3 clinical signs?
- MULTIFOCAL or SOLITARY involvement
- Seizures, paralysis, paresis
4 goals of STAGING lymphoma?
- to DETERMINE EXTENT OF DZ and ORGAN INVOLVEMENT via DIAGNOSTIC TESTS
- Identify SECONDARY medical conditions
- Assess RESPONSE TO THERAPY
- PROGNOSTIC significance
STAGING/WORK-UP of lymphoma BASICS…
1. 3 things usually done?
2. cytology of..
3. IDEALLY, try to…
- PE, B/W & UA USUALLY INDICATED!
- Cytology of ENLARGED LNs!
- IDEALLY BIOPSY but NOT ALWAYS DONE
NAME of this syndrome?
= definition & what DZ usually associated
causes swelling of what 3 regions?
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
5 PE changes associated with LYMPHOMA?
- Enlarged peripheral LNs
- Hepato-splenomegaly
- Ocular changes
- Skin changes
- Dull lung sounds
what is the MOST COMMON LYMPHOMA-RELATED HEMATOLOGIC ABNORMALITY in LYMPHOMA?
ANEMIA
what hematologic finding is common in STAGE V LYMPHOMA?
CIRCULATING LYMPHOBLASTS
what ELECTROLYTE can be affected by LYMPHOMA?
what’s the cause in LYMPHOMA?
what OTHER DZ can cause this?
HYPERCALCEMIA (~15%)
in LYMPHOMA…
–> PARAENOPLASTIC SYNDROME where PTHrP is PRODUCED
OTHER DZ = ANAL SAC CARCINOMA
goal of performing UA if we suspect LYMPHOMA?
= ASSESS RENAL FUNCTION & rule out UTI especially if considering CHEMO
what finding do we expect on THORACIC RADS for LYMPHOMA?
MILIARY DIFFUSE
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?
- FNA IS GOOD!
- 22-gauge needle
- WOOD-PECKER –> REMOVE NEEDLE FROM SYRINGE
- HISTOPATH if…
–> DEFINITIVE DIAGNOSIS wanted
–> UNSURE AFTER CYTOLOGY
WHAT TYPE OF LYMPHOMA?
MEDIASTINAL
ABDOMINAL US findings on LYMPHOMA? (2)
- ENLARGED LIVER, SPLEEN, ABDOMINAL LNs
- Spleen looks like “SWISS CHEESE”
_____ CELL LYMPHOMA PROGNOSIS > ___ CELL LYMPHOMA PROGNOSIS
B CELL LYMPHOMA PROGNOSIS > T CELL LYMPHOMA PROGNOSIS
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?
IMPORTANT BC B CELL PROGNOSIS > T CELL
FLOW CYTOMETRY used!
results in 3-5 days
PUT FNA IN SALINE
5 stages of WHO MULTICENTRIC LYMPHOMA
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
2 BIG determinants of treatment for LYMPHOMA?
- OVERALL PHYSIOLOGIC STATUS OF PATIENT
- Financial & time commitment of client
–> 19-week protocol
–> 6K
3 treatment options for LYMPHOMA?
+ WHAT’S THE TREATMENT OF CHOICE?
- 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
- CHEMOTHERAPY
–> This is the TREATMENT OF CHOICE
CHOP protocol for CHEMOTHERAPY? (4 drugs)
single-agent chemotherapy? (2 types, how often to give)
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
PROGNOSIS for LYMPHOMA..
IF TREATED WITH CHOP-BASED CHEMO…
1. remission?
2. MST for B/T cell?
3. Cure?
for ABNORMAL forms of lymphoma?
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
RESCUE therapy for LYMPHOMA…
most dogs will ____ with ____ disease, rescue therapy aims to induce ____ ____ but it’s _____
response duration?
most dogs will RELAPSE with PROGRESSIVE disease, rescue therapy AIMS TO INDUCE SECOND REMISSION but it’s DIFFICULT
Response DURATION is 1-5 months
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?
= 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
