Haematopoetic Neoplasia 2 (Annaleise Stell) Flashcards
Most effective general type of tx for lymphoma
- 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.
What non-chemo type drug is indicated in lymphoma cases?
> 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
Is chemo curative for lymphoma?
No remission not cure, will relapse
What protocol are available for tx lymphoma?
> 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
What adverse effects may lomustine have?
hepatotoxic so monitor SAMe
Which cat lymphomas is cytosine arabinoside useful for?
- renal
- CNS (cytarabine crosses BBB)
Standard maintainance for cats
- chlorambucil and prednisolone EOD
How is low grade feline GI lymphoma tx?
> oral only, few side effects
- Chlorambucil [Leukeran]
- Prednisolone
(- can use cyclophosphamide or lomustine if relapse)
Outline a low budget protocol for tx lymphoma
- Prednisolone alone
- Prednisolone + chlorambucil (monitor haem)
- Lomustine +- prednisolone (monitor carefully for myelosuppression, hepatotox)
How can lymphoma relapses be tx?
- 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
Are resuce tx often successful?
Less successful than 1* induction
How can hypercalcaEMIA BE MANAGED?
- tx lymphoma
- saline siuresis @ ~6ml/kg/hr provided no contra-indications
- once rehydrated, furosemide to ^ calciuresis
> calcitonin and bisphosphonates v Ca
6 methods of monitoring lymphoma patients on chemo
- PE to check for remission or relapse
- haem: check myelosuppression before each tx in induction
- if neutropenia 180mg/m2 cumulative (6 cycles))
How can GI disturbance d/t chemo be managed?
- 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+
How can myelosupression d/t chemo be managed?
- prophylactic Abx if neutrophils
How can haemorrhagic cystitis d/t cyclophosphamide be managed?
- 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
How does allergic reaction present in cats and dogs. How can hypersensitivity/allergic reactions be managed ? Which drugs may cause this?
- L-asparaginase and doxorubicin
- Dogs: urticarial, oedema, hyperaemia, VD+
- Cats: respiratory distress, vomiting
> stop drugs, give antihistamine and dexamethasone
How should extravasation of chemo agents be managed?
- 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
For dogs with multicentric lymphoma, How does remission rate compare for no tx, pred only, COP and CHOP?
- n/a
- 33%
- 70-80%
- 80-94%
For dogs with multicentric lymphoma, How does first remission duration compare for no tx, pred only, COP and CHOP?
- n/a
- 1mo
- 3-6mo
- 9mo