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Y4 - Small Animals > Feline lymphoma, leukaemia + myeloma > Flashcards

Feline lymphoma, leukaemia + myeloma Flashcards

1
Q

What are Pre FeLV lymphoma?

A
  • Mediastinal/multicentric lymphoma in young/adult cats
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2
Q

What is post FeLV lymphoma?

A
  • Gastrointestinal lymphoma in geriatric cats
  • > 70% of feline lymphomas
  • Most common intestinal tumour (adenocarcinoma, MCT)
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3
Q

What is relevance of FeLV / FIV with lymphoma?

A
  • Cats that are FeLV +ve are 62 times more likely to develop lymphoma
  • Cats that are FeLV + FIV +ve are 80times more likely to get lymphoma
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4
Q

What are other aetiological factors for lymphoma?

A
  • Genetic predisposition
  • Altered expression of oncogenes, tumour suppressor genes (c-myc, N-ras)
  • Epigenetic modifications
  • Tobacco smoke
  • Chronic inflammatory conditions (i.e. IBD)
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5
Q

What are different types of lymphoma in cats?

A
  • Nodal lymphoma (multicentric)
  • Alimentary lymphoma
  • Mediastinal lymphoma
  • Extranodal lymphoma =
    -Nasal/retobulbar lymphoma
    -Laryngeal lymphoma (pharynx and trachea)
    -Renal lymphoma
    -CNS lymphoma
    -Ocular lymphoma
    -Cutaneous lymphoma
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6
Q

What is nodal-multicentric lymphoma?

A
  • “True” multicentric lymphoma with symmetrical generalised lymphadenopathy is rare in cats (most common form in dogs)
  • Regional lymphadenopathy is more common - Submandibular lymph nodes, medial iliac lymph nodes…
  • Middle aged cats - Wide range
  • Generalised lymphadenopathies have been reported which mimic lymphoma - Young cats, histopathological phenomenon, generally resolve without treatment
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7
Q

What are clinical signs of nodal-multicentric lymphoma? What are differentials?

A
  • CS =
  • Non-painful lymph node enlargement
  • Anorexia
  • Depression
  • Non-specific malaise
  • Pyrexia
  • (PU/PD)

Differentials:
* Retroviral, viral, bacterial, fungal, mycobacterial and (protozoal), infections
* (Other haemopoietic malignancies)
* Immune mediated disease
* Idiopathic forms
* Metastatic disease (regional)

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8
Q

What cats get mediastinal lymphoma? What are the clinical signs? What are exam findings?

A
  • Younger cats - (Siamese cats)
  • Clinical signs =
  • Respiratory distress
  • Regurgitation/dysphagia
  • Weight loss
  • Lethargy, exercise intolerance
  • Cough (rare)

Examination findings:
* Palpable reduction in compressibility of cranial thorax
* Decreased lung sounds

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9
Q

What are Ddx for mediastinal lymphoma?

A
  • Thymoma
  • Other cranial mediastinal lymphadenopathy
  • Other causes of pleural effusion =
  • Congestive cardiac failure
  • Pyothorax
  • FIP
  • (Haemothorax)
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10
Q

What is alimentary lymphoma? CS? Who does it affect?

A
  • Older cats
  • Insidious weight loss
  • Anorexia - more common and severe in cats than dogs
  • Diarrhoea (may not be observed)
  • Malabsorption/PLE
  • Occasionally vomiting - gastric involvement, secondary gastritis, (more common in cats than dogs)
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11
Q

What are Ddx for alimentary lymphoma?

A
  • All other causes of mesenteric lymphadenopathy
  • FIP - Peritonitis of other aetiologies
  • IBD
  • Metastatic neoplasia
  • Pancreatitis
  • Mycobacterial infection
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12
Q

What is seen with extranodal lymphoma?

A
  • CNS - signs depend on site
  • Nasal/retrobulbar - nasal discharge, epistaxis, obstruction, exophthalmos etc.
  • Renal - malaise, anorexia, renomegaly (bilateral), azotaemia
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13
Q

Why is cutaneous lymphoma hard to treat?

A
  • Not very responsive to chemotherapy
  • Tx = interferon
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14
Q

How are lymphomas diagnosed?

A
  • FNA / flow cytometry
  • Biopsy - excisional (node), wedge (extranodal lesion)
  • keep fresh tissue if any chance of mycobacterial / fungal disease
  • PARR (PCR for antigen receptor rearrangements)
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15
Q

What are positive prognostic indicators for feline lymphoma?

A
  • Achieving CR (complete response)
  • small volume extranodal disease - Nasal lymphoma
  • (T cell immunophenotype in indolent lymphomas)
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16
Q

What are negative prognostic indicators for feline lymphoma?

A
  • Failure to achieve Complete response (CR)
  • FeLV +ve status
17
Q

What is Tx of lymphoma?

A
  • (None) - 4 wks median survival
  • Corticosteroids
  • Multi drug regimens =
  • COP (cyclophosamide, oncovin, prednisolone) - 75% CR, 1yr survival = 49%, 2yr survival = 40%
  • CHOP (above +doxorubicin)
  • COAP
18
Q

What are side effects of lymphoma Tx?

A
  • Myelosuppressive agents
  • Probably a good idea to intermittently check urine - UTI
  • Hair loss (whiskers)
  • GI signs
19
Q

What is Tx of alimentary lymphoma?

A
  • Surgical excision of solitary mass lesion - Must biopsy nodes (and other organs)
  • Follow up chemotherapy
  • If Extensive infiltration = Staggered induction to reduce risk of perforation
  • Adequate supportive therapy =
  • Appetite stimulants
  • O-tube
  • Vitamin B12
  • Gastric lymphoma very difficult to treat
  • LGL lymphoma has poor response to chemotherapy
20
Q

What is the outcome of feline lymphoma?

A
  • Goal is to induce complete remission - CR is no detectable tumour
  • Quality of life is paramount
  • Most cats will develop drug resistance and will relapse
  • Rescue therapy: single agent doxorubicin or lomustine (RR ~40%)
  • Could consider radiation if local disease (e.g. nasal)
  • A small percentage of cases will be cured
21
Q

What are different feline leukaemia?

A
  • Classification by cell type and progression - (Acute vs chronic, Lymphoid vs myeloid)
  • Acute lymphoid leukaemia (ALL) and acute myeloid leukaemia (AML) are rapidly progressive, fatal diseases =
  • High WBC counts
  • Concurrent pancytopenias
  • Poor prognosis (weeks-months) even with chemotherapy

*Myelodysplastic syndrome (MDS) also recognised as a precursor to acute leukaemias in FeLV positive cats
* Characterised by cytopenias (RBCs, platelets, neutrophils) without circulating neoplastic cells.

22
Q

What is acute leukaemia treatment?

A
  • Supportive therapy – very sick patients =
  • Blood transfusion
  • Antibiotics
  • Barrier nursing
  • CSF?
  • Multi-agent chemotherapy protocols
  • COP vs CHOP
  • Addition of cytarabine infusions may improve response
  • MST of ALL treated with chemotherapy is 120 days in dogs
23
Q

What is chronic leukaemia?

A
  • Neoplastic proliferation of well differentiated cells
  • Chronic lymphoid leukaemia – proliferation of mature lymphocytes in bone marrow.
  • Rare (T cell > B cell > T-ve, B-ve)
  • Lymphocyte counts >30x109/L
  • Decision to treat based on the individual (presence of CS, degree of lymphocytosis)
  • Treatment with prednisolone/chlorambucil – survival times of 1-3 years reported.
  • Chronic myeloid leukaemia – proliferation of mature myeloid cells (normally neutrophils) in bone marrow
  • Even rarer!
  • Have to exclude other causes of extreme neutrophilia; infection, immune mediated disease; paraneoplastic syndrome
  • May undergo blast crisis
24
Q

How is leukaemia diagnosed?

A
  • Haematology with manual differential and smear evaluation
  • Flow cytometry of peripheral blood
  • Staging to evaluate extent of disease =
  • Thoracic radiographs
  • Abdominal ultrasound
  • Cytology of liver/spleen
  • Bone marrow biopsy (cytology + histology)
25
Q

What are myeloma related disorders (multiple myeloma)?

A
  • Systemic neoplastic proliferation of plasma cells results in overproduction of antibody (IgA or IgG)
  • Can get local disease – extramedullary plasmacytoma which can progress to multiple myeloma
  • Hyperproteinemia can lead to hyperviscosity syndrome
    *-Neurological symptoms, retinal detachment, congestive heart failure (cats > dogs), hypertension, coagulopathy
  • Bone marrow involvement can lead to cytopenias – secondary infections
  • Renal disease present in 33-50% of dogs (multifactorial due to proteinuria, hypercalcaemia, renal infiltration, urinary infection)
26
Q

How is multiple myeloma diagnosed?

A
  • Haematology, biochemistry, urinalysis =
  • Non-specific, may see circulating plasma cells
  • Proteinuria (Bence-Jones proteins)
  • Hypercalcemia
  • Hyperglobulinemia
  • Serum protein electrophoresis - Monoclonal gammopathy
  • Diagnostic imaging = Hepatosplenomegaly, Osteolytic bone lesions
  • Cytology = Liver, spleen + bone marrow
27
Q

In dogs, for multiple myeloma diagnosis, what is needed?

A
  • In dogs have to fulfil two of the following criteria =
    1. Monoclonal gammopathy
    2. Radiographic evidence of osteolytic bone lesions
    3. >5% neoplastic plasma cells or >10-20% plasmacytosis in the bone marrow
    4. Bence-Jones proteinuria
28
Q

What is treatment of multiple myeloma?

A
  • Supportive care =
  • Blood transfusions
  • Plasmaphoeresis
  • Antibiotics if secondary infection
  • Therapy for hypercalcaemia

Systemic disease =
* Prednisolone (~ 40 days)
* Chemotherapy =
- Prednisolone 0.5mg/kg SID reducing to EOD – stop after 2 months
- Melphalan 0.1mg/kg SID reducing to 0.05mg/kg SID
- Cumulative myelosuppression is seen – perform haematology q2 weeks then monthly.
- Median survival of 540 days reported (dogs)
* Local extramedullary plasma cell disease may be treated surgically if no systemic involvement

28
Q
A

Y4 - Small Animals (105 decks)

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