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Lymphoreticular > Haematopoetic Neoplasia 2 (Annaleise Stell) > Flashcards

Haematopoetic Neoplasia 2 (Annaleise Stell) Flashcards

1
Q

Most effective general type of tx for lymphoma

A
  • systemic dz so systemic tx (ie. chemo)
  • surgical indications rare (eg. solitary site lymphoma, good for Hodgkins like lymphoma in cats, acute intestinal obstruction)
  • radiation for nasal lymphoma cats (survival 1.5-3y if responsive) and some localised lymphomas. Can also be used as RESCUE.
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2
Q

What non-chemo type drug is indicated in lymphoma cases?

A

> Prednisolone and dexamethasone

  • cause lymphocyte apoptosis
  • often in combo chemo protocols
  • can be used ALONE for palliation but effect SHORT LIVED 2-3months
  • do NOT give before making a dx, steroids promote multidrug resistance so “pre-tx” will reduce success rate in future
  • if going to use in combination, do so from the start
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3
Q

Is chemo curative for lymphoma?

A

No remission not cure, will relapse

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4
Q

What protocol are available for tx lymphoma?

A

> COP
- cyclophosphamide , vincristine, prednisolone
- induction phase + ongoing oral maintainance (chlorambucil, methotrexate, prednisolone)
CHOP
- doxorubicin containing
- more intensive initially, longer induction
- no maintainance
COAP
- COP + cytosine arabinoside first week (good for CNS involvement)
- if remission @ 8weeks, maintainance is LP/LMP (chlorambucil [Leukeran,] prednisolone, +- methotrexate)
LOPP (for high/intermediate T cell in dogs)
- vincristine, procarbazine, lomustine, prednisolone
- LMP maintainance if remission @ 6 months

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5
Q

What adverse effects may lomustine have?

A

hepatotoxic so monitor SAMe

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6
Q

Which cat lymphomas is cytosine arabinoside useful for?

A
  • renal

- CNS (cytarabine crosses BBB)

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7
Q

Standard maintainance for cats

A
  • chlorambucil and prednisolone EOD
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8
Q

How is low grade feline GI lymphoma tx?

A

> oral only, few side effects
- Chlorambucil [Leukeran]
- Prednisolone
(- can use cyclophosphamide or lomustine if relapse)

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9
Q

Outline a low budget protocol for tx lymphoma

A
  • Prednisolone alone
  • Prednisolone + chlorambucil (monitor haem)
  • Lomustine +- prednisolone (monitor carefully for myelosuppression, hepatotox)
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10
Q

How can lymphoma relapses be tx?

A
  • if not currently on tx, restart original protocol (re-induction)
  • if receiving maintainence, restart induction protocol (re-induction)
  • if relapsing during induction, use new drugs tumour not exposed to previously, preferably in combination (rescue) eg. DMAC (dex, melphalan, actinomycin D, cytarabine) or lomustine and L-asparaginase
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11
Q

Are resuce tx often successful?

A

Less successful than 1* induction

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12
Q

How can hypercalcaEMIA BE MANAGED?

A
  • tx lymphoma
  • saline siuresis @ ~6ml/kg/hr provided no contra-indications
  • once rehydrated, furosemide to ^ calciuresis
    > calcitonin and bisphosphonates v Ca
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13
Q

6 methods of monitoring lymphoma patients on chemo

A
  1. PE to check for remission or relapse
  2. haem: check myelosuppression before each tx in induction
    - if neutropenia 180mg/m2 cumulative (6 cycles))
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14
Q

How can GI disturbance d/t chemo be managed?

A
  • frequently mild and self limiting (starve 24hrs if BAR + afebrile)
    > but risk of bacterial translocation if neutropenic so if unwell/pyrexic see vet
  • may need IVFT
  • Antiemetics (maropitant, metoclopramide, ondansetron)
  • Apetite stimulants (mirtazapine, cyproheptadine)
  • Metronidazole has immunomodulatory effect with D+
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15
Q

How can myelosupression d/t chemo be managed?

A
  • prophylactic Abx if neutrophils
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16
Q

How can haemorrhagic cystitis d/t cyclophosphamide be managed?

A
  • switch to chlorambucil or melphalan
  • can be severe and slow to resolve, sometimes irreversible
    > Tx:
  • NSAIDs if not on steroids
  • Oxybutinin antispasmodic
  • GAGs
    > prevention
  • ^ water intake, give drugs morning
  • consider dividing into 2 doses
  • give furosemide concurrently
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17
Q

How does allergic reaction present in cats and dogs. How can hypersensitivity/allergic reactions be managed ? Which drugs may cause this?

A
  • L-asparaginase and doxorubicin
  • Dogs: urticarial, oedema, hyperaemia, VD+
  • Cats: respiratory distress, vomiting
    > stop drugs, give antihistamine and dexamethasone
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18
Q

How should extravasation of chemo agents be managed?

A
  • Serious!* can need amputation
  • leave catheter in place, attempt to withdraw as much as possible
  • doxorubicin ICE
  • vincristine HEAT
    > specific drugs can be given under specialist advice
  • doxorubicin: dexrazoxane IV
  • vincristine: hyaluronidase locally
    > antiinflam doses of dex IV and topical steroid cream
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19
Q

For dogs with multicentric lymphoma, How does remission rate compare for no tx, pred only, COP and CHOP?

A
  • n/a
  • 33%
  • 70-80%
  • 80-94%
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20
Q

For dogs with multicentric lymphoma, How does first remission duration compare for no tx, pred only, COP and CHOP?

A
  • n/a
  • 1mo
  • 3-6mo
  • 9mo
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21
Q

For dogs with multicentric lymphoma, How does survival time compare for no tx, pred only, COP and CHOP?

A

-

22
Q

For cats with high grade lymphoma, how does remission rate compare for no tx, pred only, COP and CHOP?

A
  • n/a
  • n/a
  • 50-80%
  • 50-70%
23
Q

For cats with high grade lymphoma, how does first remission time compare for no tx, pred only, COP and CHOP?

A
  • n/a
  • n/a
  • 3-8mo
  • 4mo
24
Q

For cats with high grade lymphoma, how does survival time compare for no tx, pred only, COP and CHOP?

A
  • 4-6weeks
  • n/a
  • 3-10mo
  • 3-10mo
25
Q

What is the 1 year survival % of cats with high grade lymphoma?

A

30%

26
Q

What is the 2 year survival rate for dogs with multicentric lymphoma?

A

20-25%

27
Q

Prognosis for GIT specific lymphoma in cats

A 
> low grade
- small cell, lymphocytc T cell 
- good prog
- chlorambucil and prednisolone
- 70% complete response, MST >2year 
> high grade
- lymphoblastic B or Large T cell shorter MST 3-10mo 
- large granular lymphocytic (LGL) subtype v poor prog (30% response, MST 1-2mo)
28
Q

Prognossis for GIT speicfic lymphoma in dogs

A
  • poor prog (MST ~77d, 6-700 range)

- except colorectal form with longer survival if COP/CHOP used

29
Q

Prognosis for localised nasal lymphoma in cats

A
  • tx radiation : good response

- most respond, MST 1.5-3y in responders

30
Q

Negative prognostic indicators for lymphoma in dogs

A
  • high grade T cell (except one subtype newly discovered with good prog) MST 1/2 that of B cell (ie. 6mo with CHOP)
  • clinical substage b
  • Hypercalcaemia (more likely with T cell phenotype)
  • BM invovlement (stage V)
  • prolonged pretx with corticosteroids
  • failure to acheive complete remission
  • site: GIT/renal/pure hepatosplenic lymphoma
31
Q

Negative prognositc indicators for lymphoma in cats

A
  • failure to acheive complete remission
  • FELV + status
  • High grade
  • LGL (large granular lymphocyte) rare variant
32
Q

What are leukaemias?

A
  • malignant neoplasia originating from haematopoietic precursor cells in BM (or sometimes spleen)
  • neoplastic cells MAY be present in circulation
  • sometime proliferate in BM but do not spill out so only cytopenias sen (ALEUKAEMIC LEUKAEMIA)
33
Q

What are the 2 main categories of leukameias?

A
  • lymphoid v myeloid

- acute v chronic

34
Q

What is acute leukaemia characterised by?

A
  • aggressive biological behaviour
  • dz progression rapid with severe clinical signs
  • immature blast cells in marrow.blood, poorly differentiated, high capacity for rapid cell division
  • POOR PROG*
35
Q

What is chronic leukaemia characterised by>

A
  • slow progression
  • clinical signs mild or incidental finding
  • neoplastic cells well differentiated late precursor cells, with lesser capactiy for division
  • PROG REASONABLE
36
Q

What are the 2 forms of lymphoid leukaemia?

A

ALL and CLL

37
Q

Which form of lymphoid leukaemia is not easily differentiated from stage V lymphoma? How do these disease differ? How can they be differentiated?

A

> ALL (disease starts in the marrow)
- sicker
- more profound cytopenia on haem
- milder lymphadenomegaly
lymphoma (disease starts peripherally and spreads to marrow)
- to differentiate use flow cytometry (ALL cells + for CD34 marker of immature haematopoietic stem cells)

38
Q

Which has a worse prognosis, ALL or stage V lymphoma?

A

ALL

39
Q

What are myeloproliferative disorders?

A
  • neoplastic AND pre-/non-neoplastic conditions of all the non-lymphoid cells in the marrow
  • uncommon and not well hcaracterised in dogs and cats
    > acute myeloid leukaemias: undifferentiated leuk, myeloblastic leuk, myelomonocytic leuk, monoblastic leuk, megakaryoytic leuk, erythroleuk, subtypes
    > myeloproliferative neoplsms/chronic myeloproliferative disorders: chronic myelogenous leukaemia, eosinophilic and basophilic leuk, 1* thrombocytosis (essential thrombocythemia, polycythaemia vera)
    > others: myelofibrosis, myeoldysplasia
40
Q

Clinical signs of leukaemia?

A
  • non specific wt loss, lethargy, malaise, anorexia, GI signs, mild generalised lymphadenopathy, hepatosplenomegaly
  • signs related to myelopthisis - fever, petechial haemorrhage, pallor, +- hypercalcaemia
41
Q

How can leukaemias be diagnosed?

A
  • if abnormal cells circulating flow cytometry distinguishes particular cellt ype invovled
  • may require BM aspirate +- core
42
Q

Tx acute leukaemias. Px?

A

> poor response rate and px (ALL: 30% response, MST 120d in dogs, response same in cats remission may last longer)
AML similar px
- pre-existing cytopenias cause problems as chemo drugs myelosuppressive ^ risk sepsis/haemorrhage
Tx ALL : potentially use same drugs as lymphoma
- start with L-asparaginase and pred as less myelosuppressive
Tx AML
- try cytosine arabinoside (no one knows how to tx this!)

43
Q

Tx chronci leukaemias? Px?

A 
> much better success rate and px!
> CLL : affects older animals,
- tx chlorambucil and pred (MST 1-3yrs) 
> CML : rare
- tx hydroxycarbamide (hydroxyurea)
- MST 4-15months
44
Q

What is myeloma?

A

plasma cell tumour affecting BM in older animals

45
Q

Clinical signs of myeloma. Dx tests and results seen…

A
  • mild pyrexia, lethargy, palor
  • mild generalised lymphadenopathy
  • hepatosplenomegaly
  • signs of hyperviscosity (eg. neuro, retinal detachment, bleeding tendencies, lameness/bone pain d/t lytic lesions in bone esp flat bones)
    > haem: mild non-regenerative anaemia, cytopenia
    > biochem: hyperglobulinaemia d/t Ab production by plasma cells (monoclonal spike on serum protein electrophoresis +- hypercalcaemia
    > radiographs: punched osteolytic lesions (vertebrae, pelvis, long bones) uncommon in cats, or diffuse osteopenia
    > urine: bencejones light chains proteinuria/ similar pattern to serum if electrophoresis carreid out
46
Q

How can myeloma be dx?

A

BM aspirate/biopsy showing increased numbers of plasma cells

47
Q

Tx myeloma?

A

DOGS - Melphalan and prednisolone (MST ~12-18mo dogs)

CATS - Melphalan -> marked myelosuppression so use chlorambucil and prenisolone

48
Q

Px myeloma?

A

Worse in cats

MST 12-18mo in dogs

49
Q

What is polycythaemia vera?

A

1* erythrocytosis

- proliferation of erythroid cell series in marrow, with differentiation to RBCs

50
Q

CLiical signs of polycythaemia vera? DDx?

A
  • bright red MMs
  • neuro signs d/t hyperviscosity of blood
  • persistently high PCV (65-85%) + low/normal EPO activity
    > Ddx
  • differnetiate from dehydration
  • appropriate causes of ^ PCV (hypoxia)
  • EPO producing tumours
51
Q

Tx polycythaemia vera?

A
  • phlebotomies
  • replacment of blood with colloids/electrolytes to alleviate hyperviscosity
  • hydroxycarbamide (hydroxyurea)

Lymphoreticular (31 decks)

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