Lymphoma Flashcards
What is the most common hematopoietic tumor?
Lymphoma
—> proliferation of malignant lymphoid cells
Etiology of lymphoma?
Genetics
Molecular aberrations
Immunological factors — chronic inflammatory dz
Infections — viral (FIV or FELV) or bacterial (helicobacter)
Immunosuppressive therapy
Toxins/insecticides
How are lymphomas anatomically classified ?
Multicentric (peripheral lymph nodes) 80-85%
Alimentary
Cutaneous
Misc - CNS, heart, nasal cavity, ocular
What are the histopatholgical classifications of lymphomas?
Low, intermediate, or high grade
What is the difference between lymphoblastic and lymphocytic lymphoma?
Lymphoblastic lymphoma - is a large cell and has a high grade (grows quickly and is more likely to spread)
Lymphocytic lymphoma- small cell and a low grade neoplasm (grows slower and is less likely to spread)
T/F: most canine lymphomas are B cell derivatives
True
T/F: prognosis is better for Tcell lymphomas than Bcell lymphomas
False
B cells is better, T cells are terrible
What are most common forms of lymphoma in felines?
Alimentary/GI form
-> most are intermediate large cells
What uncommon form of feline lymphoma is often associated with FeLV?
Mediastinal
Canine multicentric nodal lymphoma is primarily seen in what age group?
Middle-aged to older dogs
No sex or breed predilection
What is substage a vs b canine multicentric nodal lymphoma
Substage a - clinically healthy
Substage b
- lethargy, weakness and other non-specific clinical signs
- paraneoplasic hypercalcemia —>PU/PD with hyperCa
- bone marrow involvement (myelophthisis) —> neutropenia bleeding from thrombocytopenia, or anemia
Clinical signs of alimentary lymphoma ?
GI signs, vomiting, diarrhea, weight loss, inappetence
Clinical signs of canine mediastinal lymphoma?
Respiratory signs, dyspnea
Muffled heart sounds
Pre-caval syndrome (pitting edema of head, neck, and forelimbs)
50% have paraneoplasic hypercalcemia
Clinical signs of canine cutaneous lymphoma?
Plaques/nodules on the skin
Clinical signs of alimentary lymphoma in cats?
Weight loss
Unkept haircoat
Inappentace
Chronic diarrhea and vomiting
Clincial signs of feline mediastinal lymphoma??
Resp distress
Unable to compress thorax
Pleural effusion
Clinical signs of renal lymphoma?
PU/PD and renal failure
Clincial signs of feline nasal lymphoma
Sneezing and nasal discharge
What can you find on PE in an animal with lymphoma?
Palpable lymphnodes
Rectal exam - sublumbar lymph nodes
Mucous membranes pallor/petechiae
Organometallic
-splenomegaly/hepatomegaly
Intestinal wall thickening
Uveitis/retinal hemorrhage
You do a CBC on your lymphoma patient, what do you expect to find?
Anemia - normocytic normochronic non-regenerative anemia
Myelopthisis - neutropenia, thrombocytopenia, anemia
You want to do a bone marrow aspirate to stage your lymphoma dog.. where can you do this?
Greater tubercle of humerus or iliac crest
You want to do a bone marrow aspirate to stage your lymphoma CAT.. where can you do this?
Femoral intertrocanteric fossa
What can you see on a serum biochem in a lymphoma patient?
40% are hypercalcemia - PTHrp production
Azotemia - renal lymphoma
Hepatic involvement?
What test do you want to do in cats with lymphoma that is important for your diagnosis, prognosis, and husbandry for those cats?
FeLV and FIV status
What is standard of care for diagnosis of multicentric lymphoma
Histopathology of biopsy and flow-cytometry of FNA
T/F: based off of FNA, pathologists can diagnose lymphoma in cats
False
They can make the diagnosis from FNA in dogs, but not cats
Why do we want to do histopathology with lymphoma
Immunophenotype the tumor - Bcell better prognosis than Tcell
Assess grade of neoplasm
What is PARR?
PCR for antigen receptor rearrangement
Neoplasia lymphoid cells have DNA that is permanently rearranged
Bcell DNA for immunoglobulins
Tcell DNA for Tcell receptors
How can lymphoid phenotyping be done?
Flow cytometry
Immunohistochemistry (biopsy)
Immunohistochemistry (smear)
PARR
If you leave a lymphoma untreated.. what is the survival time?
4-6weeks
Chemotherapy is used for intermediate and high grade lymphoma.. what is the median remission and survival time in dogs vs cats?
Dog - 90% response rate
- > 20-25% are alive 2 years post protocol
- > remission is 8-12months
Cat - 70% response rate
- > MST 6-8months
- > remission 4-6months
What is the most common chemo protocol for canine lymphoma?
CHOP
Cyclophosphamide
Hydroxydanorubicin (doxorubicin)
Oncovin (vincristine)
Prednisone
What is the response of canine lymphoma if you decide to only treat with prednisolone?
Short lived remission, 1-2months
** if you have already used pred, response to chemo after is much lower**
What is the response rate of canine lymphoma to doxorubicin ONLY?
70% of cases respond
Remission 5 months
MST 7months
What do you do if you have a clinically significant hypercalcemia due to lymphoma?
Should disappear once you start treatment
IV fluids and diuretics (furosemide)
Prednisolone (calciuric)
Biphosphonates —> inhibit osteoclast cells
Calcitonin -> oppose action of PTH, regulate Ca and P in blood
What is the MOA of rababfosadine
Interferes with cells DNA synthesis machinery and halts growth and causes apoptosis of cells
What is the feline lymphoma treatment?
Multi-agent chemo
Some use COP protocol
—> complete response rate 50-80%
—>MST 4-6months
What does it mean for there to be complete response with lymphoma ?
Disappearance of all target lesions at >4weeks
What is the treatment for cats with a low grade small cell alimentary lymphoma?
Chlorambucil with pred
MST 2-3yrs
What is the treatment for dogs with indolent/low-grade lymphoma?
Chlorambucil and pred
OR
Cyclophosphamide and pred
Surgery is confined to spleen or single lymph node
What is your treatment for a relapsed lymphoma?
> 2 months after end of chemo —> re-induction of previous chemo protocol
<2moths and no response to chemotherapy —> use drugs not in CHOP protocol “rescue chemo”
What are prognostic factors for lymphoma?.
Stage Substage (b worse than a) Histopathology Phenotype (T worse than B) Previous pred therapy (worse prog) Mediastinal lymphoma - greater complicates and shorter response rate Anatomical location Chemo induced neutropenia - prolonged remission rate
What is a lymphoid leukemia?
Proliferation of neoplasic cells of bone marrow
Acute vs chronic
RARE disease
What are the clinical signs of acute lymphoblastic leukemia?
Lethargy Weight loss Intermittent pyrexia Hepatospenomegaly Abdominal pain Neurological signs
Anemia, thrombocytopenia, and leukopenia
Clinical signs for chronic lymphocytic leukemia?
Lethargy Pyrexia PU/PD Hemorrhage (thrombocytopenia) Intermittent lameness and collapse
Peripheral lymphocytosis
T/F: chronic lymphocytic leukemia has a better response to therapy than acute lymphoblastic leukemia
True
Clinical signs associated with multiple myeloma?
Lameness
Weakness
Lethargy
Pain
High levels of circulating gamma proteins —> hyperviscosity syndrome
- neuro signs
- bleeding diathesis
- ophthalmic abnormalities
- increased cardiac workload
Renal dz — PU/PD and dehydration
- proteinuria
- tumor into renal tissue
- hyperCa
- amyloidosis
Diagnosis of multiple myeloma ?
BM aspirate —> plasmacytosis
Serum or urine myeloma protein —> electrophoresis
Rads
- > osteolytic lesions
- > pathological fractures
- > can have bone lysisi
Treatment for multiple myeloma?
Melphalan with pred
Melphalan can cause myelosuppreesion —> thrombocytopenia so monitor CBC
Hypercalcemia therapy
Plasmapheresis for hyperviscocity syndrome
Fluid therapy for renal impairment
