Lymphoma (E2)

Question 1

What is the most common hematopoietic tumor?

Answer 1

Lymphoma

Question 2

Fill in the blanks

(E.g. Lymphoid cells in Bone Marrow – Lymphoid Leukemia
Lymohoid cells in the Body – Lymphoma)

T- and B- Lymphocytes – __________

Macrophages – ​______ leukemia

Neutrophils – ​______ leukemia

PTLs – __________

RBC – ______leukemia or __________

Answer 2

Multiple myeloma

Monocytic leukemia

Myelogenous leukemia

Primary thrombocytopenia

Erythroleukemia or Polycythemia vera

Question 3

In which ways are lymphomas classified in dogs?

Answer 3

Anatomical

Histopathological

Lymphoma type (blastic or cytic)

Phenotype

Question 4

What is the importance of phenotype and lymphoma type classification?

Answer 4

Prognostication: B-cell = Better, T-cell= Terrible

Cytic= Better than blastic

Question 5

Lymphoma is based on the number of _____ affected.

Answer 5

Lymph nodes

Question 6

How is lypmhoma classified in cats? What is the most common form?

Answer 6

Anatomic site

Small cell (low grade) vs Large cell (intermediate-high grade)

Most common: Intermediate grade Large Cell Alimentary/GI

Question 7

How do most dogs with lymphoma present?

Answer 7

Clinically healthy (substage a)

Question 8

You know what to do.

Answer 8

Lymph nodes:

1. Retropharyngeal and Submandibular
2. Prescapular
3. Axillary
4. Inguinal
5. Poplyteal

Question 10

What type of lymphoma causes dyspnea, muddled eart sounds, pre-caval syndrome, and often paraneoplastic hypercalcemia?

Answer 10

Mediastinal lymphoma

Question 11

What breed of cat is over-represented in terms of lymphoma cases?

Answer 11

Siamese

Question 12

How do most cats with lymphoma present?

Answer 12

Moderately Sick (substage b)

Often with GI signs (since alimentary is most common)

Question 13

Why is an opthamological exam important to include in your physical exam when trying to diagnose lymphoma in a dog?

Answer 13

Uveitis/Retinal hemorrhage occurs in 30-50% of dogs

Question 14

What will you generally find in a CBC in a dog with a neoplastic condition?

Answer 14

Normocytic normochronic non-regenerative anemia

Myelopthisis - neutropenia, thrombocytopenia, anemia

Question 15

What sites do you use for a bone marrow aspirate in dogs? Cats? Why is this done?

Answer 15

Dog: Greater tubercle of humerus, Iliac Crest

Cat: Demoral intertrochanteric fossa

For prognosis and staging

Question 16

What is the most common imaging modality for lymphoma diagnosis?

Answer 16

Ultrasound

Question 17

What is the gold standard for multicentric lymphoma diagnosis? Why? What will you find?

Answer 17

Histopathology of biopsy + Flow-cytomoetry of FNA

Cytology for immunophenotype, Histopath for grade of tumor

Will see - Cytology: Anisocytosis, Anisokaryosis, Multiple nulcei, Mitotic figures, Free nuclear material

IHC: stain for B and T cell markers

Question 18

How long will a dog or cat live if lymphoma is not treated?

Answer 18

4-6 weeks

Question 19

Is chemotherapy better for cats or dogs with lymphoma?

Answer 19

Dogs

Question 20

What is the most common chemo protocol for canine lymphoma?

Answer 20

Multi-agent: CHOP protocol (CDVP protocol)

Cyclophosphamide

Doxorubicin

Vincristine

Predniosolone

Question 21

Why may you not be able to treat a dog with chemotherapy if the dog is highly aggressive?

Answer 21

Because most drugs must be given IV and in hospital

Question 22

How long can a dog live with lymphoma solely on pred?

Answer 22

1-2months

Question 23

What is the most common chemotherapy protocol for cats with lymphoma?

Answer 23

Multi-Agent: Modified Wisconsin-Madison Protocol

Or: COP protocol (cyclophosphamide, vinrcristine, pred)

Question 24

What drug can you give cats with low-grade small cell alimentary lympoma?

Answer 24

Chlorambucil + Prednisolone

Question 25

What drugs/drug combinations can you give dogs with low-grade lymphoma?

Answer 25

Chlorambucil + Pred

or

Cyclophosphamide + Pred

(Surgery if confined to spleen or solitary LN)

Question 26

How long should intitial lymphoma treatment be given?

Answer 26

Until remission

Question 27

Since relapse occurs in most, if not all patients, what protocol can you use if the replapse occurs more than 2 months after the initial treatment course? Less than 2 months?

Answer 27

<2mo: Same as initial protocol

>2mo: Cannot use any drugs from initital therapy due to resistance development, “Rescue chemo” - Lomustine/CCNU, Mitoxantrone, Melphalan

Question 28

What genetic test should be performed before intitiating chemotherapy in dogs?

Answer 28

MDR-1 gene analysis

Question 29

What type of lymphoma respons well to radiation?

Answer 29

Nasal lymphoma

Question 30

What does it indicate if a dog develops chemotherapy induced neutropenia?

Answer 30

It’s a GOOD thing- indicates prolonged remission rate

Question 31

What is the proliferation of neoplastic cells in the bone marrow? How is it categorized?

Answer 31

Leukemia

Categorized as acute lymphoblastic (ALL) or chronic lymphocytic (CLL)

(Note: Acute lymphoblAstic , Chronic lymphoCytic)

Question 32

What do cats with acute lymphoblastic leukemia often test positive for?

Answer 32

FeLV

Question 33

Which form of leukemia has a better prognosis? How is it treated?

Answer 33

CLL

Chlorambucil + Pred

Question 34

What is the most likely clinical sign with multiple myeloma? What other things are often seen?

Answer 34

Most common: Lameness (due to bone destruction/fractures)

Hyperviscosity syndrome (due to high serum proteins)= neurosigns, epistaxis, eye abnormalities

Renal disease - PUPD, dehydration

Question 35

What is the treatment protocol for multiple myeloma? How would you treat hyperviscosity?

Answer 35

Melphalan + Pred

Hyperviscosity: Plasmapheresis