Feline Lymphoma

Question 1

Which breeds are predisposed to lymphomas in cats?

Answer 1

Siamese/ Oriental breeds predisposed

Question 2

What can increase a cat’s risk of developing a lymphoma?

Answer 2

Retroviruses (FeLV, FIV)
Environmental (tobacco smoke)
Chronic inflammation like IBD
Immunosuppression post transplant

Question 3

Retrovirus caused lymphomas are more likely to be B or T cell origin?

Answer 3

B Cell

Question 4

What are the three types of alimentary lymphoma in cats?

Answer 4

Low grade
High grade
Large granular lymphocyte lymphoma (arises from cytotoxic t cells)

Question 5

What is the difference between a low grade and a high grade lymphoma?

Answer 5

Low grade causes chronic clinical signs and a thickening of the muscularis layer
High grade presents as acute clinical signs with a distinct intestinal mass

Question 6

What are the two most common lymphoma locations/ types in felines?

Answer 6

Alimentary & Nasal

Question 7

Which form of lymphoma is heavily linked to FeLV infections and what age does this occur?

Answer 7

Mediastinal- occurs in young cats (approx 3 years)

Question 8

What is a Hodgkins like lymphoma?

Answer 8

slowly progressive lymphoma that starts in the mandibular/ cervical lymph node (mostly unilateral)
Classified specifically as Reed-Sternberg cells

Question 9

What may haematology show in a feline patient with lymphoma?

Answer 9

Anaemia (especially common in alimentary lymphoma)

Question 10

What may biochemistry show us in a feline patient with lymphoma?

Answer 10

Hypoalbuminaemia (especially for alimentary related)
Raised ALT, ALP and bilirubin (suggests hepatic involvement)
Azotaemia (renal involvement)

Question 11

When would we immunophenotype in feline lymphoma cases?

Answer 11

when cytology/ histopathology has not provided a definitive diagnosis
and when differentiating inflammation from neoplasia (alimentary lymphoma vs IBD)

Question 12

Do we need to stage feline lymphomas?

Answer 12

Not really as it doesn’t have a major influence on treatment or prognosis
Exceptions to this rule include- nasal lymphoma as its treated with radiotherapy if local (not chemo)

Question 13

How do we treat low grade feline lymphomas?

Answer 13

Chlorambucil and Prednisolone

Question 14

How are high grade feline lymphomas treated?

Answer 14

COP or CHOPP protocols

Question 15

What rescue protocols are recommended for feline lymphoma treatment?

Answer 15

Cyclophosphamide or Lomustine single agent

Question 16

What is the difference in outcome when using COP compared to CHOP protocols?

Answer 16

no significant difference
but Doxorubicin (CHOP) has a lower response rate and can be nephrotoxic
but CHOP protocol induces a more durable remission

Question 17

How would we treat a large granular lymphocyte lymphoma (LGL)?

Answer 17

Lomustine based protocols aka LOP

Question 18

How would we treat a feline lymphoma with Renal/ CNS involvement?

Answer 18

Cytarabine aka COAP protocol - crosses the blood brain barrier

Question 19

When is surgery for lymphoma indicated? (3)

Answer 19

Indicated for localised Hodgkin’s like lymphoma
Perforative/ obstructive intestinal masses
Subcutaneous lymphomas

Question 20

What are negative prognostic factors in feline lymphomas?

Answer 20

FeLV positive
High grade
LGL subtype

Question 21

What is the difference between a Leukaemia and a lymphoma?

Answer 21

Lymphoma comes from mature lymphocytes
Leukaemia is derived from bone marrow precursors or other haematopoietic precursors in the spleen

Question 22

What is a myeloid leukemia?

Answer 22

arises from an erythrocyte, platelet or other WBC precusor

Question 23

Does acute or chronic leukaemia have the worse prognosis?

Answer 23

Acute- more aggressive, severe clinical signs and poor prognosis (days- weeks)

Question 24

What are the main clinical signs of Leukaemia?

Answer 24

pyrexia, lethargy, mild lymphadenomegaly and hepatosplenomegaly

Question 25

How can we differentiate leukaemia and lymphoma using flow cytometry?

Answer 25

Detection of CD34- only present in leukaemia’s- not lymphomas

Question 26

How do we treat acute leukaemia?

Answer 26

CHOP protocol with addition of Cytarabine (penetrates bone marrow very well)

Question 27

How do we treat Chronic lymphoid Leukaemia?

Answer 27

Chlorambucil and Prednisolone

Question 28

How do we treat Chronic Myeloid Leukaemia?

Answer 28

Hydroxyurea

Question 29

What is a multiple myeloma?

Answer 29

Neoplasia originating in the bone marrow and arising from plasma cells

Question 30

Malignant plasma cells in multiple myelomas often overproduce…

Answer 30

Immunoglobulins

Question 31

What are the clinical signs of a multiple myeloma?

Answer 31

signs of bleeding e.g. retinal haemorrhage, bone pain, neurological signs

Question 32

What is indicative of a multiple myeloma diagnosis using Haematology & Biochemistry?

Answer 32

Cytopenias- anaemia & thrombocytopenia
Hyperglobinaemia (KEY FINDING!)

Question 33

What do we need to document the presence of to definitively diagnose multiple myeloma and how do we do this?

Answer 33

Bone marrow plasmacytosis (basically proves there’s plasma cells in the bone marrow)- use with bone marrow biopsy
Monoclonal Component- use serum protein electrophoresis to confirm monoclonal gammopathy
Osteolytic lesions- use radiographs or CT

Question 34

What is Serum protein electrophoresis used for?

Answer 34

To differentiate polyclonal/ inflammatory lesions from monoclonal/ neoplastic gammopathy

Question 35

How is multiple myeloma treated in dogs and cats?

Answer 35

Dogs- Melphalan & prednisolone
Cats- Cyclophosphamide & prednisolone