Lymphoma Flashcards
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
Why is lymphoma common?
One of the most active cells!
Has mechanisms that are in place to divide rapidly
Canine Lymphoma
Common locations
Enlarged peripheral lymph nodes (80%)
GI (10%)
Leukemia
Canine Lymphoma
Cell type
Majority are B cell
Depends on breed
Canine Lymphoma
Diagnosis and Phenotyping
B vs. T cell
Cytology: can know B vs. T cell
Flow cytometry
IHC
PARR assay (clonality)
Histopathology
Immunohistochemistry
Canine Lymphoma
Stage I
Single node (or organ)
Canine Lymphoma
Stage II
Group of nodes on one side of diaphragm (thorax or abdomen)
Canine Lymphoma
Stage III
Generalized lymph node involvement
Canine Lymphoma
Stage IV
Spleen or liver involvement (into the blood stream; easy for lymphocytes to do)
Canine Lymphoma
Stage V
Bone marrow
CNS
Canine Lymphoma
Staging
a vs. b
a: no symptoms
b: symptoms/sick (poorer prognosis)
Canine Lymphoma
Diagnostics
CBC/Chem/UA
Thoracic radiographs
Abdominal imaging; ultrasound most specific
Bone marrow aspirate
Canine Lymphoma
How important is staging
Not the most important, treatment approach is generally the same
Canine Lymphoma
Anatomical Classification
Multicentric Gastrointestinal Mediastinal Cutaneous Extranodal (heart, kidney)
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)
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
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
Canine Lymphoma
Common drugs used
Prednisone L-aspariginase -Elspar-(antimetabolite) Vincristine (mitotic spindle interrupter) Cyclophosphamide (alkylator) Doxorubicin (antitumor antibiotic) Methotrexate (antimetabolite) Lomustine (alkylator)
Canine Lymphoma
Survival/Duration of first remission
No Therapy
1 month
Especially high grade
Canine Lymphoma
Survival/Duration of first remission
Prednisone alone
2 months
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
