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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
Common drugs used to treat LSA
- 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)
26
Survival or duration of first remission (for worse prognosis) if NO therapy?
- ~1 month
27
Survival or duration of first remission (for worse prognosis) if prednisone alone (+/- chlorambucil)
~ 2 months
28
Survival or duration of first remission (for worse prognosis) if COP (cyclophosphamide, vincristine, prednisone)
~4-6 months
29
Survival or duration of first remission (for worse prognosis) if Elspar + COP
~4-6 months
30
Survival or duration of first remission (for worse prognosis) if CHOP protocol (cyclophosphamide, vincristine, prednisone, and Doxorubicin or Elspar)
- ~8-9 months
31
Best survival times?
- CHOP protocol | - COP + Elspar is not bad
32
Relationship between drugs in the protocol and duration of first remission?
- More drugs in the protocol = longer duration of first remission
33
Protocols used at WSU for lymphoma?
- COP +/- Elspar - CHOP Protocol or the Madison-Wisconsin 6 month protocol - Single agent would be doxorubicin
34
What should we factor?
- MDR1 mutant? Hard to handle? Cardiac or renal disease? - Client factors (economic, schedule) - Comfort level with drug administration, safety concerns
35
MW 6 month protocol remission rate and survival time
92% remission - Overall survival around 400 days
36
Toxicity of MW 6 month protocol
- 40% dose reductions but fewer than 10% hospitalized
37
L-asparaginase impact on CHOP protocol?
- Did not appear to increase median survival
38
Steps to take if your patient relapses with canine lymphoma?
- Start protocol over (if >6 months from induction) | - Switch to a new protocol with new drugs (more common with T cell)
39
Length of CHOP protocol
6 months
40
Rescue protocols
- Lomustine +/- Elspar - MOPP (mechlorethamine, vincristine, prednisone, procarbazine) - Doxorubicin and DTIC - Mitoxantrone - Bleomycin +? - Lomustine and Vinblastine - Tanovea
41
Survival rates of rescue protocols?
- Do not give the same types of survival as the initial | - Considered successful if at least 50% got one month additional
42
When to do surgery with LSA?
- Only if we are sure it's a single node/organ
43
When to do radiation with lymphoma?
- 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
Feline lymphosarcoma - Incidence - Breed - Risk factors - Age
- High incidence - Presentation varies with age, FeLV status, and locality - No breed predilection - MAY be related to second hand smoke
45
Young cat lymphoma vs older cat lymphoma: FeLV status and locality?
- Young cat: 4-5 years, FeLV +, mediastinal | - Older cat: 9-10 years, FeLV negative, GI or abdominal
46
Anatomic classification of feline lymphoma
- Alimentary/GI - Mediastinal - Multicentric - Nasal - Renal - Spinal (check bone marrow) - Leukemia
47
Staging lymphoma in cats
- Multiple schemes but not as helpful as in the dog - Anatomic classification most useful - Single organ involvement tends to do better
48
Histologic classification of feline LSA
- Not well established, but small cell is considered low grade
49
Treatment of high grade (large cell) LSA in cats
- Same as dogs but cats more likely to experience side effects
50
Two protocols for feline LSA at WSU
- COP +/- Elspar (intermediate grade) | - CHOP 6 month protocol (addition of doxorubicin important for internal forms)
51
Radiation therapy for feline LSA
- Single node or nasal radiation therapy useful, but be sure the cat has stage I disease only
52
Prognosis for feline LSA compared to dog
- Generally poorer, but also more unpredictable
53
Survival/remission for no treatment feline LSA?
1-2 months
54
Survival/remission for chemo with feline LSA
3-8 months
55
Survival/remission for nasal LSA
18-24 months (irradiated)
56
Survival/remission for stage V (CNS or bone marrow)
poor
57
Survival/remission for FeLV (+)
6 months
58
MW 6 month protocol for cats vs dogs
- 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
Leukemia definition
- Proliferation of a neoplastic hematopoietic cell in the bone marrow
60
How common is leukemia in pets?
- Relatively rare
61
Breed/age predilection of leukemia
- No real breed or age predilection | - Younger more aggressive in general
62
Clinical signs of leukemias
- 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
Classifications of leukemias
- Acute (blastic) or chronic (cytic) | - Lymphocytic or non-lymphocytic (erythroid, monocytic, stem cell leukemia)
64
Aleukemic leukemic
- refers to a proliferation in the bone marrow without the appearance of the abnormal cells in the peripheral blood
65
Diagnosis of acute leukemia on CBC
- Presence of BLASTS | - May require cytochemical stains or flow cytometry to determine cell origin
66
Diagnosis of chronic leukemia on CBC
- Over abundance of one MATURE cell type | - Most commonly lymphocytic
67
Diagnosis of aleukemic leukemia on CBC
- Other abnormalities including anemia, thrombocytopenia, or pancytopenias
68
Bone marrow exam of leukemia
- 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
Therapy for acute lymphocytic leukemia
- 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
Overall prognosis for acute lymphocytic leukemia
- Poor
71
Prognosis for acute non-lymphocytic leukemia
- BADNESS | - EXTREMELY POOR
72
Therapy for acute non-lymphocytic leukemia
- 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
Chronic lymphocytic leukemia prognosis
- Can be quite long (1-3 years)
74
Chronic lymphocytic leukemia treatment
- 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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