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Small Animal Medicine II > Lymphoma & Leukemia > Flashcards

Lymphoma & Leukemia Flashcards

1
Q

What are the cells of origin of lymphoma? What is the typical presentation?

A

B and T lymphocytes

  • typically no clinical signs
  • generalized peripheral lymphadenopathy +/- hepatosplenomegaly
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2
Q

What are the 5 clinical stages of canine lymphoma? What are the substages?

A
  1. only 1 peripheral LN enlarged
  2. multiple enlarged peripheral LNs on the same side of the diaphragm
  3. multiple enlarged peripheral LNs on both sides of the diaphragm
  4. liver and/or spleen involvement
  5. any other organ involvement, commonly BM, lung, and kidneys

healthy vs. sick

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3
Q

How is cytology used to diagnose lymphoma?

A

FNA of an enlarged peripheral LN shows lymphoblasts

  • careful manipulation of slides to avoid rupture of cells
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4
Q

What is seen on CBC/chem/UA in cases of lymphoma?

A

often WNL

  • lymphoblasts on smear
  • mild anemia
  • elevated ALP/ALT
  • hypercalcemia with T-cell lymphoma
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5
Q

What are some findings on thoracic radiographs and abdominal ultrasounds that can support a diagnosis of lymphoma?

A

THORACIC RADS = cranial mediastinal mass, perihilar lymphadenopathy, pulmonary parenchymal involvement

ABDOMINAL U/S = hepatomegaly, splenomegaly, enlarged sublumbar or mesenteric LNs

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6
Q

What is the purpose of phenotyping lymphoma? What are 2 options?

A

determine B-cell vs T-cell

  1. PARR assay - when cytology is not conclusive
  2. flow cytometry - determines size of neoplastic lymphocytes, can also diagnose indolent lymphoma
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7
Q

What is the prognosis of canine lymphoma like? What are some less aggressive forma?

A

typically not curable, no therapy = 6-8 weeks; typically responds well to treatment

  • indolent lymphoma
  • small cell lymphoma
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8
Q

What is the most common protocol for treating canine lymphoma? What are the 2 versions? What is the MST on this treatment?

A

CHOP —> cyclophosphamide, doxorubicin, vincristine, prednisone

  1. UW-19 = 16 treatments over 19 weeks
  2. UW-25 = 16 treatments over 25 weeks

12 months

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9
Q

What are 2 chemotherapies that can be used as core treatments of canine lymphoma? What is commonly given concurrently?

A
  1. Doxorubicin - q 3 weeks for 5 doses (MST = 7-9 months)
  2. CCNU - q 3 weeks continually (MST = 4-6 months)

prednisone

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10
Q

What is the purpose of turning to single agent therapy in cases of canine lymphoma over CHOP?

A
  • decrease severity of side effects, like GI signs and neutropenia
  • rescue after CHOP failed
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11
Q

What is a new veterinary-only chemotherapy agent available for canine lymphoma? What is its mechanism of action?

A

Tanovea (rabacfosadine) - q 3 weeks for 5 doses, MST = 6-9 months —> may be the nest rescue drug

guanine nucleotide analog - inserts into DNA, resulting in cell death during S phase

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12
Q

What is prednisone like as a single agent in treating canine lymphoma?

A
  • daily, continuous
  • easy and inexpensive
  • 2-3 month MST
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13
Q

What are the most common signs associated with GI lymphoma? How does it respond to therapy?

A

severe vomiting, diarrhea, and weight loss; typically does not infiltrate peripheral LNs

poorly —> CCNU preferred, MST of 3-4 months

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14
Q

What are the most common signs associated with cutaneous lymphoma? How does it respond to therapy?

A
  • diffuse flaking/crusting and ulceration of the skin
  • severe pruritis
  • mild peripheral lymphadenopathy

poor response to CHOP —> CCNU + prednisone with MST of 3-6 months

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15
Q

How is feline lymphoma categorized?

A

based on anatomical location

  • GI
  • renal
  • nasal
  • mediastinal
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16
Q

What are the 2 categories of feline GI lymphoma?

A
  1. LARGE CELL - more acute signs of decreased appetite, vomiting, and diarrhea with palpable mid-abdominal mass (SI + mesenteric LN)
  2. SMALL CELL - more chronic signs of decreased apetite, vomiting, diarrhea, and constipation with a RARELY palpable mid-abdominal mass (SI thickening + LNs)
17
Q

How are the 2 types of feline GI lymphoma diagnosed?

A

LARGE CELL = U/S guided FNA of mass

SMALL CELL = full thickness biopsy of small intestinal wall + PARR assay if inconclusive (poor sensitivity in cats)

18
Q

How do the treatments of the 2 types of feline GI lymphoma compare?

A

LARGE CELL = CHOP (prednisolone preferred in cats!), COP, cyclophosphamide/doxorubicin/prednisone (single-agent) —> MST of 6-9 months with CHOP

SMALL CELL = chlorambucil + prednisolone, pred alone, CCNU or cyclophosphamide rescue —> MST of 18 months to 3 years depending on resolution of GI signs

19
Q

How do feline patients with renal lymphoma commonly present? How is it diagnosed?

A

decreased appetite, lethargy, and vomiting with severely bilaterally enlarged kidneys appreciated on PE

U/S guided FNA of kidneys

20
Q

What are 4 treatment options for feline renal lymphoma? What is prognosis like?

A
  1. CHOP
  2. COP
  3. single agent cyclophosphamide
  4. prednisolone alone

poor —> transient response to therapy with MST of 3-4 months

21
Q

How do feline patients with nasal lymphoma present? How is it diagnosed?

A
  • nasal congestion, discharge, epistaxis, sneezing +/- facial distortion
  • previous treatment of upper respiratory infection with variable success
  • anatomically confined, not common for other organs to be involved

CT scan +/- biopsy (can be inconclusive due to inflammation)

22
Q

What are 5 treatment options for feline nasal lymphoma? What is prognosis like?

A
  1. radiation therapy (more confined!)
  2. CHOP
  3. COP
  4. single agent cyclophosphamide
  5. prednisolone alone

generally good response to therapy —> MST 1-2 years

23
Q

How do feline patients typically present with mediastinal lymphoma? In what cats is this most common? How is it diagnosed?

A

acute onset tachypnea/dyspnea

young, FeLV+ cats —> not common these days

thoracic radiographs and cytology of cranial mediastinal mass (large lymphocytes)

24
Q

What are 5 options for therapy of feline mediastinal lymphoma? What is prognosis like?

A
  1. CHOP
  2. COP
  3. single agent therapy (not commonly successful)
  4. prednisolone alone
  5. radiation if no other organs involved

poor/transient response to therapy —> MST 3 months (better if FeLV-)

25
Q

What animals are most commonly affected by acute lymphoblastic leukemia (ALL)? How do they present?

A

younger cats and dogs < 4 y/o

sick on presentation - lethargic, anorexia, vomiting, diarrhea, lameness, fever

26
Q

What 4 characteristics are used to differentiate ALL from stage V lymphoma?

A
  1. acute onset of clinical signs
  2. lymphadenopathy not common
  3. poor response to chemotherapy
  4. short survival times

+ EXTREME leukocytosis

27
Q

What are the 6 most common findings on clinical pathology associated with ALL?

A
  1. greatly elevated WBCs - large lymphoblasts counted as monocytes
  2. lymphoblasts in BM
  3. nonregenerative anemia
  4. moderate to severe thrombocytopenia
  5. elevated liver enzymes
  6. increased BUN
28
Q

What treatment is used for ALL? What is prognosis like?

A

CHOP + rescue protocols

short-term response to therapy —> poor prognosis

29
Q

What animals are most commonly affected by chronic lymphocytic leukemia? How do they present?

A

older dogs and cats

not sick on presentation - often an incidental finding and difficult to differentiate from small cell or indolent lymphoma

30
Q

What are the 2 most common clinical pathology findings in cases with CLL?

A
  1. variably elevated lymphocytes - these neoplastic lymphocytes are commonly able to be counted as lymphocytes (compared to ALL)
  2. excessive small lymphocytes in BM

often no other significant findings!

31
Q

What is the most common treatment plan used for CLL?

A

monitor without treatment

  • often incidental!!
32
Q

What are the 2 major indications for treating CLL? Why is it important to treat at this point? What is considered the best treatment?

A
  1. lymphocyte count > 50000/uL
  2. disease causing illness

at this point, it can mutate into more aggressive disease

chlorambucil + prednisone —> offers control for years

Small Animal Medicine II (57 decks)

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