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Oncology > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

How common is canine lymphoma?

Age-ish?

Breeds?

A
  • VERY COMMON IN DOGS
  • Breeds: Boxer, basset Hounds, St. Bernards, Scottish terriers, Airedailes, Bulldogs, Rottweillers, Golden Retrievers
  • Age ~6-7 years old
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2
Q

Where can canine lymphoma occur, and where does it most often occur?

A
  • Can occur anywhere
  • Enlarged peripheral LNs common (~80%)
  • GI and others <10%
  • Leukemia
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3
Q

Are lymphomas in dogs more often T cell or B cell?

A
  • MOST often B cell but depends on breed
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4
Q

Cytology for lymphoma

A
  • Quite helpful
  • Flow cytometry (can’t do with a smear!)
  • Immunocytochemistry
  • PARR assay
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5
Q

Histopath for lymphoma

A
  • Immunohistochemistry
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6
Q

Stage I lymphoma

A
  • Single node or organ
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7
Q

Stage II lymphoma

A
  • Group of nodes on one side of the diaphragm
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8
Q

Stage III lymphoma

A

Generalized LN involvement

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9
Q

Stage IV lymphoma

A
  • Spleen or liver
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10
Q

Stage V lymphoma

A
  • Bone marrow, CNS, or other organs
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11
Q

Substage a lymphoma

A
  • No signs
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12
Q

Substage b lymphoma

A
  • Clinical signs/sick
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13
Q

What tests for staging lymphoma?

A
  • CBC/Chem/UA
  • Chest rads (even lymph nodes won’t make you higher than a stage III)
  • Abdominal imaging
  • Bone marrow aspirate
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14
Q

What type of imaging for the abdomen?

A
  • Ultrasound more sensitive and specific

- Aspirate liver and spleen (I think regardless if they appear normal or not)

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15
Q

Importance of staging in lymphoma?

A
  • You can’t cure lymphoma with surgery, so it’s a little tougher to know the importance
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16
Q

Anatomic classifications of lymphoma

A
  • Multicentric (peripheral lymph nodes)
  • GI
  • Mediastinal
  • Cutaneous
  • Extranodel
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17
Q

Histo classification with lymphoma

A
  • Likely IMPORTANT
  • Not always done the same
  • Cytology or flow cyometry of biopsy is important
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18
Q

What are the three grades of lymphoma?

A
  • Low grade (small cell)
  • Intermediate grade (diffuse large cell)
  • High grade (immunoblastic)
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19
Q

Is staging or grading more helpful for determining tumor bheavior?

A
  • Usually grading is more helpful
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20
Q

Treatment of lymphoma (general category: chemo, radiation, +/- surgery)?

A
  • Very sensitive to chemotherapy but usually not curable
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21
Q

Remission rates and survival times of lymphoma

A
  • 85-90% achieve remission with chemotherapy

- Average survival is ~ 1 year

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22
Q

How do you define remission?

A
  • Whatever they detected has gone away

- Clinical remission

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23
Q

Factors associated with a poorer prognosis of lymphoma

A
  • Substage b
  • Stage greater than III
  • T-cell
  • Hypercalcemia
  • Icterus
  • Hypoproteinemia
  • Prior prolonged treatment with glucocorticoids
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24
Q

Why does prior treatment with glucocorticoids lower prognosis?

A
  • For months

- It means that you’ve lost prednisone as a drug to induce remission

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25
Q

Common drugs used to treat LSA

A
  • Prednisone (corticosteroid)
  • L-asparagine or Elspar (anti-metabolite enzyme)
  • Vincristine (mitotic spindle interruptor)
  • Cyclophosphamide (alkylator)
  • Doxorubicin (antitumor antibiotic)
  • Methotrexate (antimetabolite)
  • Lomustine (alkylator)

Rabacfosadine (Tanovea or newer targeted prodrug for lymphoma)

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26
Q

Survival or duration of first remission (for worse prognosis) if NO therapy?

A
  • ~1 month
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27
Q

Survival or duration of first remission (for worse prognosis) if prednisone alone (+/- chlorambucil)

A

~ 2 months

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28
Q

Survival or duration of first remission (for worse prognosis) if COP (cyclophosphamide, vincristine, prednisone)

A

~4-6 months

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29
Q

Survival or duration of first remission (for worse prognosis) if Elspar + COP

A

~4-6 months

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30
Q

Survival or duration of first remission (for worse prognosis) if CHOP protocol (cyclophosphamide, vincristine, prednisone, and Doxorubicin or Elspar)

A
  • ~8-9 months
31
Q

Best survival times?

A
  • CHOP protocol

- COP + Elspar is not bad

32
Q

Relationship between drugs in the protocol and duration of first remission?

A
  • More drugs in the protocol = longer duration of first remission
33
Q

Protocols used at WSU for lymphoma?

A
  • COP +/- Elspar
  • CHOP Protocol or the Madison-Wisconsin 6 month protocol
  • Single agent would be doxorubicin
34
Q

What should we factor?

A
  • MDR1 mutant? Hard to handle? Cardiac or renal disease?
  • Client factors (economic, schedule)
  • Comfort level with drug administration, safety concerns
35
Q

MW 6 month protocol remission rate and survival time

A

92% remission

  • Overall survival around 400 days
36
Q

Toxicity of MW 6 month protocol

A
  • 40% dose reductions but fewer than 10% hospitalized
37
Q

L-asparaginase impact on CHOP protocol?

A
  • Did not appear to increase median survival
38
Q

Steps to take if your patient relapses with canine lymphoma?

A
  • Start protocol over (if >6 months from induction)

- Switch to a new protocol with new drugs (more common with T cell)

39
Q

Length of CHOP protocol

A

6 months

40
Q

Rescue protocols

A
  • Lomustine +/- Elspar
  • MOPP (mechlorethamine, vincristine, prednisone, procarbazine)
  • Doxorubicin and DTIC
  • Mitoxantrone
  • Bleomycin +?
  • Lomustine and Vinblastine
  • Tanovea
41
Q

Survival rates of rescue protocols?

A
  • Do not give the same types of survival as the initial

- Considered successful if at least 50% got one month additional

42
Q

When to do surgery with LSA?

A
  • Only if we are sure it’s a single node/organ
43
Q

When to do radiation with lymphoma?

A
  • Selected locations
  • Nasal LSA in cats (careful staging required)
  • Half body radiation therapy (irradiate half the body twice)
  • Whole body radiation therapy and bone marrow transplantation
44
Q

Feline lymphosarcoma

  • Incidence
  • Breed
  • Risk factors
  • Age
A
  • High incidence
  • Presentation varies with age, FeLV status, and locality
  • No breed predilection
  • MAY be related to second hand smoke
45
Q

Young cat lymphoma vs older cat lymphoma: FeLV status and locality?

A
  • Young cat: 4-5 years, FeLV +, mediastinal

- Older cat: 9-10 years, FeLV negative, GI or abdominal

46
Q

Anatomic classification of feline lymphoma

A
  • Alimentary/GI
  • Mediastinal
  • Multicentric
  • Nasal
  • Renal
  • Spinal (check bone marrow)
  • Leukemia
47
Q

Staging lymphoma in cats

A
  • Multiple schemes but not as helpful as in the dog
  • Anatomic classification most useful
  • Single organ involvement tends to do better
48
Q

Histologic classification of feline LSA

A
  • Not well established, but small cell is considered low grade
49
Q

Treatment of high grade (large cell) LSA in cats

A
  • Same as dogs but cats more likely to experience side effects
50
Q

Two protocols for feline LSA at WSU

A
  • COP +/- Elspar (intermediate grade)

- CHOP 6 month protocol (addition of doxorubicin important for internal forms)

51
Q

Radiation therapy for feline LSA

A
  • Single node or nasal radiation therapy useful, but be sure the cat has stage I disease only
52
Q

Prognosis for feline LSA compared to dog

A
  • Generally poorer, but also more unpredictable
53
Q

Survival/remission for no treatment feline LSA?

A

1-2 months

54
Q

Survival/remission for chemo with feline LSA

A

3-8 months

55
Q

Survival/remission for nasal LSA

A

18-24 months (irradiated)

56
Q

Survival/remission for stage V (CNS or bone marrow)

A

poor

57
Q

Survival/remission for FeLV (+)

A

6 months

58
Q

MW 6 month protocol for cats vs dogs

A
  • In cats, complete response is about half that of dogs, which is close to 90%
  • Partial response in cats is higher
  • Overall survival is about half in cats what it is in dogs, and same with duration of first response
59
Q

Leukemia definition

A
  • Proliferation of a neoplastic hematopoietic cell in the bone marrow
60
Q

How common is leukemia in pets?

A
  • Relatively rare
61
Q

Breed/age predilection of leukemia

A
  • No real breed or age predilection

- Younger more aggressive in general

62
Q

Clinical signs of leukemias

A
  • In general, nothing obvious
  • Weakness/depression/lethargy/anorexia
  • Fever
  • Bleeding
  • Signs of hypercalcemia
  • Sometimes asymptomatic
  • Other times lymphadenopathy, splenomegaly, neuro signs, ocular signs (uveitis or hyphema), bone pain, lameness joint swelling
63
Q

Classifications of leukemias

A
  • Acute (blastic) or chronic (cytic)

- Lymphocytic or non-lymphocytic (erythroid, monocytic, stem cell leukemia)

64
Q

Aleukemic leukemic

A
  • refers to a proliferation in the bone marrow without the appearance of the abnormal cells in the peripheral blood
65
Q

Diagnosis of acute leukemia on CBC

A
  • Presence of BLASTS

- May require cytochemical stains or flow cytometry to determine cell origin

66
Q

Diagnosis of chronic leukemia on CBC

A
  • Over abundance of one MATURE cell type

- Most commonly lymphocytic

67
Q

Diagnosis of aleukemic leukemia on CBC

A
  • Other abnormalities including anemia, thrombocytopenia, or pancytopenias
68
Q

Bone marrow exam of leukemia

A
  • Assists in diagnosis of cell type (lymphocytic or myelogenous)
  • Also aids in estimating prognosis - shows what is still present in bone marrow
  • may require IHC for definitive diagnosis
69
Q

Therapy for acute lymphocytic leukemia

A
  • Treatable but requires more aggressive tx than solid forms
  • Anthracycline and Elspar +/- Cytosar
  • Support therapy can be difficult if all cell lines are damaged
  • Remission is shorter than for solid forms
70
Q

Overall prognosis for acute lymphocytic leukemia

A
  • Poor
71
Q

Prognosis for acute non-lymphocytic leukemia

A
  • BADNESS

- EXTREMELY POOR

72
Q

Therapy for acute non-lymphocytic leukemia

A
  • Must be aggressive and started ASAP
  • Cytosine arabinoside plus anthracycline
  • Support can be very difficult; no white cells, no platelets, no red cells in adequate quantities until remission is achieved
73
Q

Chronic lymphocytic leukemia prognosis

A
  • Can be quite long (1-3 years)
74
Q

Chronic lymphocytic leukemia treatment

A
  • Chronic disease in dogs, rare in cats
  • Lymphocyte numbers can be quite high (30k-200k)
  • Chlorambucil every other day alternating with prednisone every other day
  • Survivals can be quite long

Oncology (9 decks)

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