Lymphoma Flashcards by Brittany Jermalovic

Canine lymphoma

Background

> 90% of canine hemolymphatic neoplasia

A round cell tumor!

One of the most common cancers seen in the dog

Signalment:
Boxer, Basset Hounds, St. Bernards, Scottish terriers, Airdales, Bulldogs, Rottweillers, Goldens

Age: 6-7 years

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Why is lymphoma common?

One of the most active cells!

Has mechanisms that are in place to divide rapidly

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Canine Lymphoma

Common locations

Enlarged peripheral lymph nodes (80%)
GI (10%)
Leukemia

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Canine Lymphoma

Cell type

Majority are B cell

Depends on breed

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Canine Lymphoma

Diagnosis and Phenotyping

B vs. T cell

Cytology: can know B vs. T cell
Flow cytometry
IHC
PARR assay (clonality)

Histopathology
Immunohistochemistry

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Canine Lymphoma

Stage I

Single node (or organ)

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Canine Lymphoma

Stage II

Group of nodes on one side of diaphragm (thorax or abdomen)

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Canine Lymphoma

Stage III

Generalized lymph node involvement

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Canine Lymphoma

Stage IV

Spleen or liver involvement (into the blood stream; easy for lymphocytes to do)

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Canine Lymphoma

Stage V

Bone marrow

CNS

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Canine Lymphoma
Staging
a vs. b

a: no symptoms
b: symptoms/sick (poorer prognosis)

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Canine Lymphoma

Diagnostics

CBC/Chem/UA
Thoracic radiographs
Abdominal imaging; ultrasound most specific
Bone marrow aspirate

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Canine Lymphoma

How important is staging

Not the most important, treatment approach is generally the same

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Canine Lymphoma

Anatomical Classification

Multicentric
Gastrointestinal
Mediastinal
Cutaneous
Extranodal (heart, kidney)

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Canine Lymphoma

Histologic Classification

Not always done but more useful than staging

Get:
Low grade (small cell)
Intermediate grade (diffuse large cell)
High grade (immunoblastic; 90%, B cell)

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Canine Lymphoma

Treatment Success

Extremely sensitive to chemotherapy but usually NOT curable

85-90% will achieve remission with chemo (no longer showing clinical signs, no longer hypercalcemic)

Average survival is 1 year

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Canine Lymphoma

Factors associated with poorer prognosis

Substage b
Stage greater than III
T-cell
Hypercalcemia
Icterus
Hypoproteinemia
Long history of being on Pred

Means will most likely not live past 1 year

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Canine Lymphoma

Common drugs used

Prednisone
L-aspariginase -Elspar-(antimetabolite)
Vincristine (mitotic spindle interrupter)
Cyclophosphamide (alkylator)
Doxorubicin (antitumor antibiotic) 
Methotrexate (antimetabolite)
Lomustine (alkylator)

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Canine Lymphoma
Survival/Duration of first remission
No Therapy

1 month

Especially high grade

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Canine Lymphoma
Survival/Duration of first remission
Prednisone alone

2 months

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Canine Lymphoma
Survival/Duration of first remission
COP

Cyclophosphamide
Vincristine
Prednisone

4-6 months

Canine Lymphoma
Survival/Duration of first remission
Elspar+COP

L-aspariginase
Cyclophosphamide
Vincristine
Prednisone

4-6 months

Canine Lymphoma
Survival/Duration of first remission
COP + Doxo +/- Elspar

AKA: Madison Wisconsin Protocol 
L-aspariginase 
Doxorubicin
Cyclophosphamide
Vincristine
Prednisone

8-9 months

What occurs when a patient is out of remission?

May no longer respond to chemo drugs

Canine Lymphoma Survival/Duration of first remission Doxorubicin

4-6 months

Canine Lymphoma | What to do at relapse

Start your protocol over | Switch to new protocol with new drugs (T cells especially)

Canine Lymphoma | Rescue protocols

Lomustine +/- Elspar Doxorubicin and DTIC Lomustine and Vinblastine

Lymphoma | Other treatment besides chemotherapy

Surgery: only if it is know to be in a single node - must stage it Radiation therapy: certain locations (ex. nasal) Entire body radiation and bone marrow transplantation

Feline Lymphoma | Background

High incidence of lymphoma in cats Presentation varies with age, FeLV status, locality No breed predilection May be related to second hand smoke; toxin ingested when grooming self

Feline Lymphoma | Young cat

4-5 years old FeLV (+) Mediastinal

Feline Lymphoma | Older cat

9-10 years FeLV (-) GI or abdominal

Feline Lymphoma | Anatomic Location

``` Alimentary/GI Mediastinal Multicentric Nasal Renal Nasal Renal Spinal Leukemia ```

Feline Lymphoma | Classification: Stage

Multiple schemes but not as helpful as in the dog Anatomical classification most useful Single organ involvement tends to do better

Feline Lymphoma | Treatment of high grade

Same drugs as in dogs, but cats are more likely to experience side effects ``` COP +/- Elspar Madison Wisconsin (especially for GI) ```

Feline Lymphoma | Radiation Therapy

Single node or nasal; must be Stage I only

Feline Lymphoma Survival/remission No Treatment

1-2 months

Feline Lymphoma Survival/remission Chemotherapy

3-8 months | Even up to 2 years

Feline Lymphoma Survival/remission Nasal lymphosarcoma

18-24 months

Feline Lymphoma Survival/remission Stage V

Poor prognosis

Feline Lymphoma Survival/remission FeLV(+)

6 months

Leukemia | What is it?

Proliferation of neoplastic hematopoetic cell in bone marrow then spreads via blood A round cell tumor! Relatively rare No real breed or age predilection

Leukemia | Clinical Signs

``` Weakness/depression/lethargy/anorexia Fever Bleeding Signs of hypercalcemia Asymptomatic Lymphadenopathy Splenomegaly Neurologic signs ```

Leukemia | Classification

Acute (blastic) or chronic Lymphocytic (treatable) or non-lymphocytic

Leukemia | What is aleukemic leukemic

Proliferation in the bone marrow without the appearance of the abnormal cells in the peripheral blood

Leukemia Diagnosis-CBC Acute

Presence of blasts May require cytochemical stains or flow cytometry to determine cell origin Growing fast

Leukemia Diagnosis-CBC Chronic

Over abundance of one mature cell type (slow progression) Most commonly lymphocytic Cells not going through apoptosis

Leukemia Diagnosis-CBC Aleukemic

Anemia Thrombocytopenia Pancytopenias

Leukemia | Diagnosis-Bone Marrow

Assists in diagnosis of cell type (lymphocytic or myelogenous) Estimating prognosis May require IHC for definitive diagnosis (tells you what cell type it is)

Leukemia | Therapy-Acute Lymphocytic Leukemia

Treatable but requires aggressive treatment than solid forms Anthracycline and Elspar +/- Cytosar Remission time = shorter than solid forms

Leukemias | Therapy-Acute Non-Lymphocytic Leukemia

Prognosis extremely poor ``` Aggressive therapy done ASAP Cytosine Arabinoside (can also combine with anthracycline) ``` No white cells, no platelets, no RBCs

Leukemia | Therapy - Chronic Lymphocytic Leukemia

Chronic disease in dogs, rare in cats Lymphocytosis (extreme) Chlorambucil every other day alternating with pred Survival: 1-3 years