Lymphoma Flashcards
what can be seen on a CBC with lymphoma?
hypercalcemia
hypoproteinemia
hyperglobinemia
what are the common breeds with lymphoma?
boxers
bulldogs
bassets
rottweilers
retrievers
beagles
what is staging?
clinical assessment of the extent of lymphoma in the body
what can you use to assess stage of lymphoma?
bloodwork
thoracic radiographs
abdominal ultrasound
what determines if an animal with lymphoma is substage a or b?
a: clinically healthy, no systemic signs
b: clinically ill, systemic signs
what is immunophenotype?
determining the type of lymphocyte based on surface antigens
what is PARR?
PCR for antigen-receptor rearrangement
dogs with ______ cell lymphoma have shorter remission and survival times than with _______ cell lymphoma
T
B
do dogs with substage b or substage a have worse prognoses?
substage b
what is the mainstay of treatment for lymphoma?
chemotherapy
what do chemotherapy drugs target?
DNA or mitotic apparatus and halt cell division
what percentage of patients have significant adverse effects?
<25%
what are median survival times with CHOP-based protocols?
B cell: 12-14 months
T cell: 6-9 months
what is median survival for lymphoma without treatment?
4-6 weeks
what drugs are given in CHOP-based protocols?
cyclophosphamide/cytoxan
hydroxydaunorubicin/doxorubicin and adriamycin
oncovin/vincristine
prednisone
what is a unique toxicity with doxorubicin in CHOP?
cardiac toxicity: acute ventricular arrhythmias and cumulative toxicity similar to DCM
what is partial remission?
at least 30% decrease in sum of lymph node diameter
what are cautions with L-asparaginase?
anaphylaxis
resistance, usually after 2-3 doses
acute tumor lysis syndrome
what is acute tumor lysis syndrome?
rapid die-off of lymphoma or leukemia cells causes electrolyte disturbances
what is median survival time of gastrointestinal lymphoma?
2-3 months
what are most cutaneous lymphomas?
most tend to be T cell
epitheliotropic
what is leukemia?
disease originates in bone marrow
which cat breeds are predisposed to lymphoma?
siamese
DSH
what can be felt on abdominal palpation with low grade/small cell lymphoma in cats?
intestinal thickening
how can you diagnose low grade/small cell lymphoma in a cat?
definitive: need histopathology
cytology usually insufficient to differentiate small cell from IBD
what is treatment and prognosis of feline lymphoma dependent on?
more on anatomic location than staging
what is the response rate to chemotherapy with low grade/small cell lymphoma in cats?
> 80%
what is the prognosis of mediastinal lymphoma in cats?
poor if FeLV+: 2-3 months
good if FeLV-: about a year
what does lymphoma originate from?
lymphoid tissues: lymph nodes, spleen, bone marrow
may affect any organ
what is large cell lymphoma like?
high grade, large lymphocytes
rapidly dividing, rapid progression if untreated
what is small cell lymphoma like?
low grade, small lymphocytes
slowly-dividing, more chronic
what is precaval syndrome in dogs often related to?
mediastinal mass
swelling of face and forelimbs
which lymph nodes should you not do fine needle aspirates on?
mandibular lymph nodes: drain the oral cavity
what is stage I lymphoma?
single lymph node
what is stage II lymphoma?
regional lymph nodes, same side of diaphragm
what immunophenotypes are B lymphocytes?
CD79a
CD20
CD21
what immunophenotypes are T lymphocytes?
CD3
CD5
CD4: helper T
CD8: cytotoxic T
what are cells separated by in flow cytometry in immunophenotyping?
size and granularity: B vs T cell
what is the hallmark of malignancy?
clonality
which stages have better prognoses?
stages I and II > III, IV, V
V is more guarded
where do chemotherapy drugs have their greatest effects?
rapidly dividing cells
how are chemotherapy side effects usually controlled?
supportive medications
what are the treatment options for lymphoma in dogs?
multi-agent, CHOP-based protocols: gold standard
single-agent protocols
prednisone alone
no treatment
what is the unique toxicity to cyclophosphamide in CHOP?
sterile hemorrhagic cystitis
what is the unique toxicity to vincristine in CHOP?
ileus
what is progressive disease?
at least 20% increase in sum of lymph node diameter
what is remission rate with CHOP in dogs?
80-95%
what is L-asparaginase’s mechanism of action?
asparagine depletion
lymphoma cells lack L-asparagine synthetase but normal lymphocytes have
halts protein synthesis in lymphoma cells
what is L-asparaginase reserved for?
when patients are sick at diagnosis or relapse
when patients are neutropenic and disease is progressing
what electrolyte changes are seen with L-asparaginase?
hyperphosphatemia
hypocalcemia
hyperkalemia
+/- azotemia
what are the treatment alternatives to CHOP?
doxorubicin
tanovea/rabacfosadine
CCNU/lomustine
how is gastrointestinal lymphoma treated in dogs?
CHOP
CCNU: less GI toxicity
how is cutaneous lymphoma treated?
CHOP
CCNU potentially better efficacy
what is the CBC like in patients with acute lymphoblastic leukemia?
circulating lymphoblasts or “unclassified cells”
neutropeenia, thrombocytopenia, anemia
how is acute lymphoblastic leukemia treated?
CHOP: challenging with cytopenias
supportive care: blood transfusions and antibiotics
what is prognosis of acute lymphoblastic leukemia?
poor
median survival 1-4 months with CHOP chemotherapy
which dogs usually get indolent lymphoma/leukemia?
golden retrievers
shih tzus
what is prognosis of indolent lymphoma/leukemia?
good
median survival 2-3 years
risk transformation to large cell lymphoma
are FeLV and FIV associated with feline lymphoma?
FeLV rare
FIV possible
what are the sites of feline lymphoma?
gastric/intestinal infiltration
mesenteric lymph nodes
liver and/or spleen involvement
peripheral lymph node enlargement rare in cats
what are the three histologic subtypes of feline lymphoma?
low grade/small cell GI lymphoma: most common
high grade/large cell GI lymphoma
large granular lymphoma: least common, most aggressive
what is clinical progression like of high grade/large cell?
acute
what is abdominal ultrasound like in high grade/large cell feline lymphoma?
gastric or intestinal mass
loss of normal wall layering
lymphadenopathy
+/- effusion
what is large granular lymphoma like on cytology?
magenta granules seen within lymphoblasts
what is treatment of low grade/small cell feline lymphoma?
oral chemotherapy: chlorambucil or prednisolone
frequent, lower doses
what does prognosis of feline GI lymphoma depend on?
histologic grade
response to treatment
low grade: transmural extension
high grade: many negative prognostic factors
what is median survival time of low grade/small cell feline GI lymphoma?
1.5-3 years
what is survival or large granular feline GI lymphoma?
2-3 months with treatment
response poor: 30%
how do cats with mediastinal lymphoma present?
acute respiratory distress
dyspnea
effusion
what are kidneys like with feline renal lymphoma?
enlarged, irregular
frequently bilateral
classic ultrasound appearance
what is median survival of feline nasal lymphoma?
1-3 years if cats achieve complete remission