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Lymphoreticular and haematopoeitic > Haemopoienic neoplasia 1 & 2 > Flashcards

Haemopoienic neoplasia 1 & 2 Flashcards

1
Q

Define lymphoma

A

diverse group of malignant neoplasms that originate from lymphoreticular cells

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2
Q

Where does lymphoma originate?

A

LNs, spleen, or LT almost anywhere in the body

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3
Q

How common is canine lymphoma?

A

one of the commonest malignant tumours in dogs

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4
Q

Signalment - canine lymphoma

A
  • middle aged to aolder (6-9yo) but can be any age
  • Boxers, Scottish Terriers, Bassets, Bulldogs, lab retrievers, airedales, st bernards
  • familial inicdences (bull mastiffs and rottweilers)
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5
Q

Aetiology - canine lymphoma

A
  • unknown
  • genetics (breeds)- chromosomal abnormalities and mutations in tumour suppressor genes (p53) and oncogenes
  • environment (herbicides, strong magnetic fields, residence in industrial areas weakly/moderately associated)
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6
Q

Incidence - feline lymphoma

A

one of commonest malignant tumours in cats

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7
Q

Signalment - feline lymphoma

A
  • median age is 9-11y but can be any age
  • previously common in younger cats but FeLV vaccine has changed this
  • young siamese and oriental cats (mediastinal lymphoma)
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8
Q

Aetiology - feline lymphoma

A
  • FeLV positive (recombination of FeLV genetic material with host DNA –> oncogenic transformation. Immunosuppression too)
  • Vaccination has reduced FeLV positive cases
  • FIV positive but unknown mechansim, possibly immunosuppression
  • genetics? (siamese and oriental and mediastinal type)
  • sites of chronic inflammation (IBD?)
  • immunosuppression (cyclosporine post renal-transplant)
  • spontaneous
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9
Q

Commonest presentation of canine lymphoma

A

multicentric lymphoa (80-85% cases in dogs):
- peripheral lymphadenopathy (markedly enlarged LNs, painless, moveable, multiple)
- often asymptmatic
- sometimes vague lethargy, malaise, wt loss, anorexia, pyrexia, PU/PD if hypercalacemic
+/- hepatosplenomegly

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10
Q

Ddx - canine multicentric lymphoma

A
  • disseminated infxn causing lymphadenitis
  • I-M dz
  • other haematopoetic tumours (leukaemia, myeloma)
  • metastatic/ disseminated neplasia of other types (histiocytic sarcoma, MCT)
  • generalised skin dz
  • sterile granulomatous lymphadenitis
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11
Q

What is the 2nd commonest presentation of canine lymphoma?

A

GIT lymphoma (approx 7% cases)

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12
Q

CS - canine GIT lymphoma

A
  • COMMON: wt loss, anorexia, vomiting, diarrhoea
  • OCC: jaundice if concurrent liver involvement
  • localised mass or multifocal/diffuse thick loops of intestine +/- mesenteric LN enlargemetn on exam
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13
Q

Ddx - canine GIT lymphoma

A
  • IBD (esp with diffuse thickening of intestine)
  • other GI tumours
  • FB
  • intussusception
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14
Q

How common is canine mediastinal lymphoma?

A

3rd commonest case, approx 3% cases

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15
Q

CS - canine mediastinal lymphoma

A
  • cranial mediastinal mass +/- pleural fluid
  • dyspnoea
  • tachypnoea
  • cough
  • wt loss
  • regurgitation
  • heart sounds ventrally
  • loss of chest compressibility (cats)
  • horner’s
  • caval syndrome
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16
Q

What phenotype does canine mediastinal lymphoma tend to be?

A

often TC type

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17
Q

Do you get hypercalcaemia with mediastinal lymphoma?

A

yes can do:

  • common in dogs, rare in cats
  • CS: PD, PU, dehydration, malaise, vomiting, bradycardia, mm tremors, constipation
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18
Q

Ddx - canine mediastinal lymphoma

A
  • other tumurs (thymoma, ectopic thyroid tumour, thymic carcinoma, chemodectoma, metastatic neoplasia)
  • non-neoplastic mass lesions: abscess, granulomatous disease, cyst
  • other causes of effusion: pyothorax, chylothorax, heart failure, haemothorax
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19
Q

Location - cutaneous lymphoma

A

solitary or generalised, variable presentation

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20
Q

What are the 2 forms of canine cutaneous lymphoma?

A
  • epitheliotropic form ‘ mycosis fungoides’

- non-epitheliotropic form

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21
Q

Describe the epitheliotropic form of canine cutaneous lymphoma

A
  • TC
  • 3 stages: scaling, alopecia, pruritus –> erythematous, thickened, ulcerated, exudative –> proliferative plaques and nodules with progressive ulceration
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22
Q

Describe the non-epitheliotropic form of canine cutaneous lymphoma

A
  • TC or BC

- affects mid to deep dermis, sparing the epidermis

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23
Q

Ddx - canine cutaneous lymphoma

A
  • infectious dermatitis
  • I-M dermatitis
  • histiocytic skin disease
  • other cutaneous neoplasia (MCT or metastatic neoplasia)
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24
Q

What are the extranodal types of lymphoma that occur in dogs?

A
  • hepatic
  • splenic
  • ocular lymphoma
  • renal
  • CNS/ spinal
  • nasal/ nasopharyngeal, laryngeal/tracheal
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25
Q

Describe canine ocular lymphoma

A
  • seen alone or with generalised disease

- signs of uveitis, blepharospasm, infiltration, haemorrhage, retinal detachment

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26
Q

What is the commonest presentation of feline lymphoma?

A

GIT (>50% cases)

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27
Q

CS - feline GIT lymphoma

A
  • wt loss
  • anorexia
  • V and or D
    +/- jaundice if concurrent liver involvement
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28
Q

What are the 2 forms of feline GIT lymphoma?

A
  • high grade form

- low grade form

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29
Q

Describe the high grade form of feline GIT lymphoma

A
  • often presents with mass lesions (GI mass/ mesenteric LN)
  • relatively short hx of illness
  • may have signs of GIT obstruction
  • median age 10y
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30
Q

Describe the low grade form of feline GIT lymphoma

A
  • may be diffuse thickening of intestinal loops or mild lymphadenopathy
  • may be more chronic hx (months)
  • median age 13 y
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31
Q

Ddx - GIT lymphoma

A
  • IBD (especially with diffuse thickening of itnestines)
  • other GI tumours
  • FB, intussusception
  • r/o other dz of elferly cats causing wt loss (hyperthyroidism, renal failure, DM)
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32
Q

What is the 2nd commonest type of feline lymphoma?

A

Mediastinal lymphoma (10-20% cases)

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33
Q

Describe feline mediastinal lymphoma

A
  • ranial mediastinal mass +/- pleural fluid, other sites may be affected concurrently
  • tends to occur in younger cats
  • often TC phenotype
  • hypercalcaemia is rare in cats vs dogs
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34
Q

Ddz - feline mediastinal lymhoma

A
  • other tumours (thymoma, ectopic thyroid tumour, thymic carcinoma, chemodectoma, metastatic neoplasia)
  • non-neoplastic mass lesions: abscess, granulomatous disease, cyst
  • other causes of effusion (FIP, pyothorax, chylothorax, heart failure, haemothorax)
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35
Q

What can be a classic sign of feline mediastinal lymphoma?

A

loss of compressibility of thorax wall

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36
Q

Describe feline nodal lymphoma

A
  • generalised peripheral lymphadenopathy alone unusual in cats (4-10% cases) but up to 25%% cats have enlarged LNs as a component of dz
  • in pure nodal forms, single LN/ regional LN enlargement is more common than multiple. An uncommon distinct form exists, called Hodgkin’s-like lymphoma/ TC rich BC lymphoma, which typically involves solitary or regional LNs of head and neck
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37
Q

Ddx - feline nodal lymphoma

A

AS FOR DOGS:

  • disseminated infxn causing lymphadenitis
  • I-M dz
  • other haematopoetic tumours (leukaemia, myeloma)
  • metastatic/ disseminated neplasia of other types (histiocytic sarcoma, MCT)
  • generalised skin dz
  • sterile granulomatous lymphadenitis
  • benign hyperplastic LN syndromes (unique to cat)
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38
Q

Describe feline renal lymphoma

A
  • 5-10% cases
  • large irregular kidneys on palpation (often bilateral), signs of kidney dz (PD/PU, anorexia, wt loss)
  • median age 9y
  • can be concurrent with lymphoma elsewhere (GIT)
  • 40-50% tx cats develop CNS lymphoma (unknown why)
  • often intermediate-high grade
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39
Q

Ddx - feline renal lymphoma

A
  • polycystic kidney disease
  • pyelonephritis
  • FIP
  • acute renal failure
  • hydronephrosis
  • perinephric pseudocyst
  • other renal tumours (carninoma)
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40
Q

Describe feline hepatic/splenic lymphoma

A
  • 5-10% cases
  • CS: malaise, jaundice (if liver involved)
  • maybe concurrent with GIT lymphoma /other sites)
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41
Q

Ddx - feline hepatic/ splenic lymphoma

A
  • other splenic masses (feline MCT, HSA)

- other causes of hepatic enlargement/ jaundice (cholangiohepatitis, other neoplasia)

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42
Q

How common is feline nasal/nasopharyngeal lymphoma?

A

5-10% cases, tends to be older cats

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43
Q

Describe feline nasal/nasopharyngeal lymphoma

A

75% BC, often localised but can spread to local LNs or pop up elsewhere later on. Often intermediate to high grade

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44
Q

CS - feline nasal/ nasopharyngeal lymphoma

A
  • chronic nasal discharge (serosanguinous to mucopurulent)
  • epistaxis
  • sneezing
  • stertor
  • anorexia
  • facial deformity
  • exophthalmos
  • epiphora
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45
Q

Ddx - feline nasal/ nasopharyngeal lymphoma

A
  • cat flu
  • other neoplasms (adenocarcinoma)
  • fungal infxn (Cryptococcus)
  • lymphocytic rhinitis
  • dental disease
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46
Q

Describe feline laryngeal/ tracheal lymphoma

A
  • older cats (9y)
  • present with URT obstruction
  • dyspnoea
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47
Q

How common is feline CNS/ spinal lymphoma?

A
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48
Q

Describe CNS/ spinal lymphoma

A
  • spinal or intracranial: often multiple regions affected
  • intra- or extradural
  • > 80% have mixed site involvement (esp renal and /or BM)
  • Presentation: insidious or rapidly progressive neuro signs depending on lesion localisation
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49
Q

Signs of feline ocular lymphoma

A
  • infiltrates
  • uveitis
  • glaucoma
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50
Q

Ddx - feline CNS / spinal lymphoma

A
  • other CNS tumours (meningioma)
  • trauma, intervertebral disc prolapse/ hernia
  • infection: FIP, mycotic infection
  • AT(E)
  • discospondylitis
  • FeLV-associated non-neoplastic myelopathy
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51
Q

What is the incidence of feline cutaneous lymphoma?

A

Rare in cats

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52
Q

What are the 2 main paraneoplastic syndromes that can be seen with lymphoma?

A
  • hypecalcaemia
  • hypergammaglobulinaemia
  • (rarely: IM-disease, polyneuropathy, hypoglycaemia)
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53
Q

Why does hypercalcaemia of malignancy require urgent tx?

A

as can –> renal failure (d/t reduced RBF and /or nephrocalcinosis)

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54
Q

Describe hypercalcaemia of lymphoma

A
  • 10-40% dogs with lymphoma (usually TC), rare in cats
  • PU/PD d/t nephrogenic DI (Ca interferes with ADH)
  • dehydration, depresson, lethargy, weakness, vomiting, consitpation, bradycardia/ bradydysryhthmias, mm tremors
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55
Q

Describe hypergammaglobulinaemia of malignancy

A

rarely, canine lymphomas have a monoclonal gammopathy d/t aberrant Ab production. Can cause hyperviscosity.

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56
Q

What should you do if the 1st presentation of an immune-mediated disease is when the animal is older?

A

check for neoplasia (i.e. immune-mediated disease of malignancy - aberrant Ab responses can trigger IMHA and IMT).

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57
Q

What should you focus your PE on if you suspect lymphoma?

A
  • LN palpation (all accessible nodes, include rectal exam in dogs)
  • MM
  • abdominal palpation (mass lesions, organomegaly - liver and spleen, peritoneal fluid)
  • thoracic auscultation, persucssion and compression (Cats)
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58
Q

Describe LN aspirates

A
  • if peripheral LNs enlarge, perform LN asprates for cytology.
  • often diagnostic - safe, quick, easy
  • 23G needle, multiple sites
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59
Q

Why choose LNs other than submandibular to aspirate?

A

as submandibular likely to be reactive to dental dz etc

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60
Q

When might you do a USG-aspirate of internal LN?

A
  • if superficial LNs not enlarged

- if liver, spleen or mediastinal mass

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61
Q

Describe ultrasound for feline GIT lymphoma

A
  • HIGH GRADE: loss of normal gut layering and mass lesions, mesenteric lymphadenopathy
  • LOW GRADE: muscularis propria layer often appears thick (also IBD shows this), mesenteric LNs may be enlarged but often not marked.
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62
Q

How do you diagnose high/low grade GIT lymphomain cats

A
  • HIGH: do a FNA or mass lesions or enlarged LNs

- LOW (diffuse GIT thickening): full thickness biopsy needed

63
Q

How do you diagnose lymphoma in cases where FNA cytology is not diagnostic/ not feasible? 4

A

LN, mass or organ biopsies for histopathology:

  • SX BIOPSY: remove whole LN, biopsy mass, full thickness GIT tract biopsies for low grade GI lymphoma
  • TRU-CUT: LNs (hard to interpret architecture), mass, liver
  • ENDOSCOPE: GIT (but full-thickness may be required to get deep enough biopsies, especially feline low grade GIT lymphoma)
  • PUNCH BIOPSY: skin
64
Q

How useful can cytology of abdominal or pleural fluid or CSF analysis be?

A

can be useful

65
Q

How can lymphoma be classified?

A
  • cytological/ histopathological morphology
  • grade
  • immunophenotype (i.e. BC or TC)
66
Q

What is the most common classification of lymphoma in dogs?

A

diffuse large BC lymphoma

67
Q

How does immunophenotype affect prognosis in canine lymphoma?

A
  • Intermediate and high grade lymphoma: BC better prognosis, TC worse prognosis
  • more work needed to assess whether immunophenotype affects prognosis in cats
68
Q

What sample is needed for immunophenotyping?

A

LN aspirates expressed in Cytocheck medium (a preservative)

69
Q

What cell surface markers classify lymphoma?

A
  • BC = CD79a, CD21+

- TC = CD3+, CD4+ or CD8+

70
Q

Are canine lymphomas usually TC type?

A

No - 80% are BC origin

71
Q

What immunophenotype does mediastinal lymphoma tend to be?

A

TC often

72
Q

How does immunophenotype affect tx choice?

A
  • DOGS - INTERMEDIATE/HIGH TC - alkylating agents (lomustine)
  • TC: modified LOPP (lomustine, vincristine, procarbazine, prednisolone)
  • BC: COP or CHOP
73
Q

Does high/intermediate BC or TC lymphoma in dogs carry a better prognosis?

A

BC has better prognosis

74
Q

Define PARR

A

= PCR for Antigen Receptor Rearrangement (aka clonality assay)

75
Q

What is PARR?

A
  • used to clarify diagnosis
  • if PCR is used to amplify the DNA encoding the Ag -R region from lymphoma cells, a single band will be obtained following electrophoresis of the PCR products
  • with an inflammatory/ other non-neoplastic diseae process, the population of lymphoid cells would be polyclonal. with each cell having a different piece of DNA encoding the Ag-R region. PARR analysis would give multiple bands/ a smear pattern follwoign electrophoresis
76
Q

What further work up can be done after a diagnosis of lymphoma has been made?

A
  • haematology (cell counts and smear)
  • biochemistry
  • urinalysis
  • serum B12
  • FeLV/ FIV testing inc ats
  • staging
  • imaging
  • sampling and cytology
  • BM aspirate or biopsy
77
Q

What should you look for on haematology when lymphoma has been diagnosed?

A
  • general health status: check for cytopaenias or abnormal circulating cells (BM infiltration sign). essential baseline before chemo
  • anaemia often present (mild, normochromic, normocytic, non-regenerative)
  • cytopaenias: if multiple cell lines affected suspected BM
    infiltration
  • atypical circulating lymphocytes/ lymphoctyosis
78
Q

What should you look for on haematology when lymphoma has been diagnosed?

A
  • organ function ( paraneioplastic effects and prior to chemo)
  • railed liver enzymes and/or bilirubin (suggesting hepatic infiltration)
  • azotaemia (with renal infiltration, hypercalcaemic nephropahty or pre-renal)
  • hypercalcaemia
  • hyperglobulinaemia
  • hypoproteinaemia (GI loss in alimentary lymphoma)
79
Q

What should you look for on UA when lymphoma has been diagnosed?

A
  • baseline info

- prior to starting cyclophosphamide (–> haemorrhagic cystitis in dogs)

80
Q

Why measure serum B12 when lymphoma has been diagnosed?

A

often low because problems absorbing B12 and may need supplementation

81
Q

Why test for FeLV/ FIV when lymphoma has been diagnosed?

A

FeLV + has a poorer prognosis

82
Q

What is the stage of the disease?

A

= the extent of the disease in the body

83
Q

Outline the WHO staging for canine lymphoma

A

1 = solitary node involved or LT in single organ
2 = involvement of multile LNs in a single region (one side of diaphragm)
3 = generalised LN involvement (both sides of diarphragm)
4 = liver and/or spleen involvement
5 = BM involvement +/- other organs (1-4)
SUBSTAGE A: no systemic signs
SUBSTRAGE B: with systemic signs (worse prognosis)
* not well suited staging system for FELINE lymphoma d/t different presentation, useful to assess extent of dz

84
Q

What are you looking for with thoracic radiography in an animal diagnosed with lymphoma?

A
  • sternal or tracheobronchial lymphadenopathy
  • mediastinal mass
  • interstitial/ alveolar/ nodular / mixed lung patterns
  • pleural effusion
85
Q

What are you looking for with abdominal radiography in an animal diagnosed with lymphoma?

A
  • hepatomegaly
  • splenomegaly
  • renomegaly
  • abdominal lymphadenopathy
  • masses
86
Q

What are you looking for with abdominal ultrasound in an animal diagnosed with lymphoma?

A
  • changes in echogenicity of internal organs (liver, spleen, kidney)
  • organ enlargement (esp liver, spleen)
  • abdominal lymphadenopathy
  • abdominal masses
  • GI lymphoma (thickened gut wall/ masses/ loss of layering / mesenteric lymphadenopathy. Cats with low grade lymphoma have thickened muscularis propria, also IBD has this pattern. High grade - loss of normal gut layering and mass lesions. Mesenteric lymphadenopathy)
  • mediastinal masses
87
Q

When might BM aspirate or biopsy be indicated?

A

if owner wants to do full staging (abnormal circulating or cytopaenias in > 1 cell line may suggest BM involvement)

88
Q

What is the minimumdatabase prior to starting tx?

A

haematology
biochemistry
UA

89
Q

What is the most effective tx for lymphoma (broadly-speaking)?

A

combination chemo

systemic tx

90
Q

Indications - surgical tx of lymphoma

A
  • indications are rare
  • e.g. solitary site lymphoma (good for Hodgkin’s like lymphoma in cats)
  • acute intestinal obstruction
91
Q

When is radiation tx the tx of choice?

A
  • nasal lymphoma in cats (1.5-3 yr MST if respond to tx)
  • some localised lymphomas
  • some studies suggest whole/half body radiation along with chemo may be beneficial to consolidate and prolong remission
  • rescue therapy sometimes
92
Q

Outline corticosteroid use in lymphoma tx

A
  • prednisolone and dexamtheasone –> lymphoctye apoptosis, often used in combination protocols
  • alone for palliation (2-3months efficacy)
  • don’t use before diagnosis
  • promote MDR so if planning to give chemo, it is best not to pre-treat with steroids for a prolonged period but use them in combination from outset.
93
Q

Outline chemo and lymphoma

A
  • discuss goals with owner (remission not cure usually)
  • potential adverse effects (QoL, better than humans)
  • owner commitment (incl. patient temperament)
94
Q

Components of COP protocol

A
  • cyclophosphamide, vincristine and prednisolone

- tends to have induction phase + ongoing oral maintenance phase (chlorambucil, methotrexate and prednisolone)

95
Q

Outline CHOP protocols

A
  • contain doxorubicin
  • more intense intially
  • longer induction phase
  • no maintenance phase
  • e.g. Madison-Wisconsin
96
Q

What does choice of protocol depend on?

A
  • clinician and owner preference, at RVC:
  • high grade canine BC lymphoma: CHOP or COP/COAP
  • Intermediate to high grade TC lymphoma: modified LOPP
  • high grade feline lymphoma: COP or COAP
  • low grade feline lymphoma: chlorambucil + prednisolone
97
Q

Mechanism - cyclophosphamide

A

ALKYLATING AGENT:
substitutes an alkyl group for H+ in DNA causing cross-linkage and breaking of DNA strand, thus interfering with DNA replication and transcription. Not cell cycle specific.

98
Q

Mechanism - vincristine

A

MITOTIC SPINDLE INHIBITOR:

binds to tubulin and prevents normal assembly of microtubules. Causes arrest of mitosis in metaphase.

99
Q

Mechanism - prednisolone

A

Cause apoptosis of lymphoid and mast cellsf

100
Q

Mechanism - doxorubicin

A

ANTI-TUMOUR ANTIBIOTIC:
several mechanisms to prevent DNA and RNA synthesis. Inhibit topoisomerase 2, breaks DNA strands, cross-links DNA base pairs, free radical oxidative damage. Not cell cycle specific, but act more in the S-phase.

101
Q

Give examples of some low-budget protocols

A
  • prednisolone alone daily then EOD
  • prednisolone as above + chlorambucil every 14d
  • lomustine q21d in dogs q3-6 weeks in cats +/- prednisolone (must monitor carefully for myelosuppression, hepatotoxicity)
102
Q

What should you do when lymphoma relapses after tx?

A

REINDUCTION AND RESCUE THERAPY:

  1. if animal not currently receiving tx - restart original protocol (re-induction)
  2. if animal is receiving a less intense maintenance protocol - go back to original inductio (re-induction)
  3. if relapse occurs during protocol - use new drugs that tumour has not been exposed to, preferably in combination therapy (rescue therapy)
103
Q

How successful are rescue attempts than primary induction?

A

less successful in terms of response rates and duration

104
Q

How can hypercalcaemia of malignancy (lymphoma) be managed)?

A
  • prompt diagnosis and management of lymphoma
  • saline diuresis (0.9%NaCl) at 6ml/kg/hr if no CIs
  • once rehydrated, start furosemide at 1-2mg/kg to promote calciuresis
  • tx underlying cause ASAP
  • other meds to specifically lower Ca may help (Calcitonin, bisphosphonates).
105
Q

How should lymphoma patients be monitored during chemo?

A
  1. ) regular PE for remisison/relapse
  2. ) haematology
  3. ) biochemistry
  4. ) B12 levels in animals with GIT lymphoma
  5. ) UA
  6. ) echocardiography
106
Q

How often should haematology be done when monitoring lymphoma patients on chemo?

A

check for myelosuppression ideally before each tx in induction phase:
if neutropaenia of

107
Q

What should be looked for on biochemistry when monitoring lymphoma patients on chemo?

A
  • abnormal parameters
  • check ALT prior to lomustine dosing
  • clinical judgement for frequency
108
Q

Administration route for vit B12 injection

A

SQ

109
Q

Why do UA when monitoring a lymphoma patient on chemo?

A
  • general health montiroing
  • monitoring for haemorrhagic cystis (dogs - cyclophosphamide)
  • urine dipstick and USG periodically
  • remember increased infxn risk with chemo
110
Q

Why perform echocardiography when monitoring a lymphoma patient on chemo?

A

offer prior to doxorubicin in dogs, screen for heart dz and assess FS%. Risks are higher is exceeding 180mg/m2 cumulative dose.

111
Q

Describe GI disturbances following chemo

A
  • frequently self-limiting and milkd
  • if BAR, afebrile: starve for 24hr then bland diet
  • may require IVFT
  • anti-emetics and gut protectants: maropitant, metoclopramide, ondansetron (most potent)
112
Q

What appetite stimulants might be given for anorexia d/t chemotherapy?

A

cyproheptadine, mirtazepine OR feeding tubes.

113
Q

What to do if animal develops myelosuppression with chemo for lymphoma

A
  • if marked neutropaenia (
114
Q

What should you do if a dog with a cyclophosphamide chemo develops haemorrhagi cystitis?

A
  • stop cyclophosphamide
  • switch to chlorambucil/ melphalan
  • severe and slow to resolve (sometimes irreversible)
  • tx: NSAIDs if prednisolone tx has ceased
  • oxybutinin anti-spasmodic,
    GAGs
115
Q

Prevention - haemorrhagic cystitis in dogs

A
  • encourage water intake
  • give cyclophsophamide in morning
  • allow frequnecy urination during day
  • if giving high dose - dive over 2d + concurrent furosemide
116
Q

Which chemo drugs may elicit a hypersensitivity reaction?

A

L-asparaginase and doxorubicin
DOGS: urticaria, oedema, hyperaemia, V+D
CATS; respiratory distress, vomiting

117
Q

What to do if chemo drug elicits a hypersensitivity reaction

A

stop drug tx and give antihistamine and dexamethasone

118
Q

What to do if extravasation of chemo drug occurs

A
  • leave catheter in place
  • withdraw as much drug as possible
  • apply ice (doxorubicin) or heat (vincristine)
  • seek specialist advice
  • specific drugs can minimise consequences: hyaluronidase locally for vincristine extravasation and dexrazoxane IV for doxorubicin extravasation
  • anti-inflammatory doses of dexamethasone IV and topical steroid creams might be useful
119
Q

What is the remission rate for canine multicentric lymphoma?

A
  • prednisolone 33%
  • COP 70-80%
  • CHOP 80-94%
120
Q

What is the median first remission duration for canine multicentric lymphoma?

A
  • prednisolone 1 month
  • COP 3-6 months
  • CHOP 9 months
121
Q

What is the MST for canine multicentric lymphoma

A
  • no tx 4-6 wks
  • prednisolone 2-3 mo
  • COP 7-10 months
  • CHOP 1 year (2 year survival of 20-25%)
122
Q

What isthe remission rate for feline low grade lymphoma?

A
  • COP 50-80%

- CHOP 50-70%

123
Q

What is the MST for feline low grade lymphoma?

A
  • no tx 4-6 wks
  • COP 3-10 months (high) grade)
  • CHOP 3-10 mo (high grade), 1 year survival at 30%
124
Q

Px - feline low grade, small cell, lymphocytic TC GIT lymphoma

A

GOOD prognosis with chlorambucial + prednisolone (around 70% complete response rate and MST > 2years)

125
Q

Px - feline high grade lymphoblastic GIT lymphoma (BC or TC)

A
  • shorter MST 3-10 mo
126
Q

Px - canine GI lymphoma. What is the exception to this?

A
  • often poor (MST up to 77d).

- colorectal form can have prolonged survival (yrs) with COP/CHOP

127
Q

Px - localised nasal lymphoma in cats with radiation tx

A

GOod - most respond, MST 1.5-3 years

128
Q

Negative prognostic indicators for canine lymphoma

A
  • TC immunophenotype for high grade lymphoma (half MST of BC lymphoma)
  • clinical substage b (i.e. unwell)
  • hypercalcaemia (likely d/t TC phenotype)
  • BM involvement / stage 5
  • prolonged pre-tx with corticosteroids
  • failure to achieve complete remission
  • SITE: GIT/ renal/ pure hepatosplenic
129
Q

Negative prognostic indicators for feline lymphoma

A
  • failure to achieve complete remission
  • FeLV positive
  • high grade vs. low grade
  • LGL (large granular lymphocyte) lymphoma (rare variant) has v. poor prognosis
130
Q

Define leukaemia

A
  • malignant neoplasms originating from haematopoietic precursor cells in BM (sometimes spleen).
  • neoplastic cells present in circulation, sometimes large #
  • sometimes neoplastic cells are proliferating in marrow, causing cytopaenias, but don’t spill over into the circulation (aleukaemic leukaemia)
131
Q

Define acute leukaemia

A
  • aggressive
  • rapid progression
  • severe CS
  • blasts in marrow or blood, poorly differentiated, high capacity for rapid division
  • poor px
132
Q

Define chronic leukaemia

A
  • slow course
  • CS canbe mild (sometimesincidental)
  • neoplastic cells well0dfferentiated, late precursors, lesser capacity for divison
  • reasonable px
133
Q

Name 2 lymphoid leukaemias

A
  • acute lymphoblastic leukaemia (ALL)

- chronic lymphocytic leukaemia (CLL)

134
Q

Differentiate ALL and stage 5 lymphoma

A

ALL: dz starts in marrow, sicker, more profound cytopaenia, milder lymphadenopathy, poorer px vs. stage 5 lymphoma
* FLOW CYTOMETRY: identifies ALL cells positive for CD34, a marker of immature haematopoietic stem cells.

135
Q

Define myeloproliferative disorders

A

neoplastic and possibly pre- or non-neoplastic conditions of all the non-lymphoid cells in the marrow
- uncommon

136
Q

List acute myeloid leukaemias

A
  • undifferentiated leukaemia
  • myeloblastic leukaemia
  • myelomonocytic leukaemia
  • monoblastic leukaemia
  • megakaryocytic leukaemia
  • megakaryoblastic leukaemia
  • erythroleukaemia
  • subtypes of above
137
Q

List chronic myeloproliferative disorders

A
  • chronic myelogenous leukaemia
  • eosinophilic and basophilic leukaemia
  • primary thrombocytosis (essential thrombocytosis)
  • polycythemia vera
138
Q

CS - leukaemias

A
  • non specific
  • signs related to myelophthisis (fever, petechial haemorrhages, pallor)
  • sometimes hypercalcaemia signs
139
Q

Dx - leukaemia

A
  • flow cytometry (if abnormal cells circulating, esepcially useful to determine type of cell involved)
  • BM aspirate +/- core
140
Q

Px - acute leukaemias

A
  • poor response (
141
Q

Tx - acute leukaemias (ALL and AML)

A
  • ALL: potentially use same drug as lymphoma (start with l-asparaginase which isn’t myelosuppressive and pred)
  • AML: try cytosine arabinosdie
142
Q

Tx - chronic leukaemias

A
  • better success rate and prognosis!
  • CLL (older animals): chlorambucil + pred
  • CML (rare): hydroxycarbamide (hydroxyurea)
143
Q

Define myeloma

A

Plasma cell tumour affecting BM (or spleen) of older animals

144
Q

CS - myeloma

A
  • mild pyrexia
  • lethargy
  • pallor
  • mild generalised lymphadenopathy
  • hepatosplenomegaly
  • signs of hyperviscosity (neuro signs, retinal detachment, bleeding, lameness/ bone pain)
145
Q

Haematology - myeloma

A

mild non-regenerative anaemia, cytopaenias

146
Q

Biochemistry - myeloma

A
  • hyperglobulinaemia (often, d/t Ab production by plasma cells) –> monoclonal spike on serum protein electrophoresis
    +/- hypercalcaemia
147
Q

Radiographs - myeloma

A
  • punched out osteolytic lesions (vertebrae, pelvis, long bones) or diffuse osteopaenia. Uncommon in cats.
148
Q

Urine -myeloma

A
  • Ig light chains (Bence-Jones proteinuria)

- similar pattern to serum if electrophoresis is performed

149
Q

Dx - myeloma

A
  • BM aspiration/biopsy –> increased # plasma cells
150
Q

Tx - myeloma

A

melphalan + prednisolone (MST 12-18 mo)

- CATS: melphalan causes marked myelosuppression –> use chlorambucil + prednisolone instead, px worse in cats

151
Q

What is polycythemia vera/ primary erythrocytosis?

A

proliferation of the erythroid cell series in the marrow, with differentiation to mature RBC

152
Q

CS - polycythemia vera

A
  • bright red MM
  • neuro signs (d/t hyperviscosity)
  • persistently high PCV (65-85%)
  • low/normal erythropoietin activity
153
Q

What do you need to differentiate polycythemia vera from?

A
  • dehydration
  • appropriate causes of incresed RBC (hypoxia)
  • EPO producing tumours
154
Q

Tx - polycythemia vera

A

phlebotomies and replacement of blood with colloids/ electrolytes to alleviate hyperviscosity; hydroxycarbamide (= hydroxyurea)

Lymphoreticular and haematopoeitic (21 decks)

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