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Lymphoreticular > Haematopoetic Neoplasia 2 (Annaleise Stell) > Flashcards

Haematopoetic Neoplasia 2 (Annaleise Stell) Flashcards

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1
Q

Most effective general type of tx for lymphoma

A
  • systemic dz so systemic tx (ie. chemo)
  • surgical indications rare (eg. solitary site lymphoma, good for Hodgkins like lymphoma in cats, acute intestinal obstruction)
  • radiation for nasal lymphoma cats (survival 1.5-3y if responsive) and some localised lymphomas. Can also be used as RESCUE.
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2
Q

What non-chemo type drug is indicated in lymphoma cases?

A

> Prednisolone and dexamethasone

  • cause lymphocyte apoptosis
  • often in combo chemo protocols
  • can be used ALONE for palliation but effect SHORT LIVED 2-3months
  • do NOT give before making a dx, steroids promote multidrug resistance so “pre-tx” will reduce success rate in future
  • if going to use in combination, do so from the start
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3
Q

Is chemo curative for lymphoma?

A

No remission not cure, will relapse

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4
Q

What protocol are available for tx lymphoma?

A

> COP
- cyclophosphamide , vincristine, prednisolone
- induction phase + ongoing oral maintainance (chlorambucil, methotrexate, prednisolone)
CHOP
- doxorubicin containing
- more intensive initially, longer induction
- no maintainance
COAP
- COP + cytosine arabinoside first week (good for CNS involvement)
- if remission @ 8weeks, maintainance is LP/LMP (chlorambucil [Leukeran,] prednisolone, +- methotrexate)
LOPP (for high/intermediate T cell in dogs)
- vincristine, procarbazine, lomustine, prednisolone
- LMP maintainance if remission @ 6 months

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5
Q

What adverse effects may lomustine have?

A

hepatotoxic so monitor SAMe

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6
Q

Which cat lymphomas is cytosine arabinoside useful for?

A
  • renal

- CNS (cytarabine crosses BBB)

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7
Q

Standard maintainance for cats

A
  • chlorambucil and prednisolone EOD
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8
Q

How is low grade feline GI lymphoma tx?

A

> oral only, few side effects
- Chlorambucil [Leukeran]
- Prednisolone
(- can use cyclophosphamide or lomustine if relapse)

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9
Q

Outline a low budget protocol for tx lymphoma

A
  • Prednisolone alone
  • Prednisolone + chlorambucil (monitor haem)
  • Lomustine +- prednisolone (monitor carefully for myelosuppression, hepatotox)
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10
Q

How can lymphoma relapses be tx?

A
  • if not currently on tx, restart original protocol (re-induction)
  • if receiving maintainence, restart induction protocol (re-induction)
  • if relapsing during induction, use new drugs tumour not exposed to previously, preferably in combination (rescue) eg. DMAC (dex, melphalan, actinomycin D, cytarabine) or lomustine and L-asparaginase
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11
Q

Are resuce tx often successful?

A

Less successful than 1* induction

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12
Q

How can hypercalcaEMIA BE MANAGED?

A
  • tx lymphoma
  • saline siuresis @ ~6ml/kg/hr provided no contra-indications
  • once rehydrated, furosemide to ^ calciuresis
    > calcitonin and bisphosphonates v Ca
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13
Q

6 methods of monitoring lymphoma patients on chemo

A
  1. PE to check for remission or relapse
  2. haem: check myelosuppression before each tx in induction
    - if neutropenia 180mg/m2 cumulative (6 cycles))
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14
Q

How can GI disturbance d/t chemo be managed?

A
  • frequently mild and self limiting (starve 24hrs if BAR + afebrile)
    > but risk of bacterial translocation if neutropenic so if unwell/pyrexic see vet
  • may need IVFT
  • Antiemetics (maropitant, metoclopramide, ondansetron)
  • Apetite stimulants (mirtazapine, cyproheptadine)
  • Metronidazole has immunomodulatory effect with D+
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15
Q

How can myelosupression d/t chemo be managed?

A
  • prophylactic Abx if neutrophils
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16
Q

How can haemorrhagic cystitis d/t cyclophosphamide be managed?

A
  • switch to chlorambucil or melphalan
  • can be severe and slow to resolve, sometimes irreversible
    > Tx:
  • NSAIDs if not on steroids
  • Oxybutinin antispasmodic
  • GAGs
    > prevention
  • ^ water intake, give drugs morning
  • consider dividing into 2 doses
  • give furosemide concurrently
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17
Q

How does allergic reaction present in cats and dogs. How can hypersensitivity/allergic reactions be managed ? Which drugs may cause this?

A
  • L-asparaginase and doxorubicin
  • Dogs: urticarial, oedema, hyperaemia, VD+
  • Cats: respiratory distress, vomiting
    > stop drugs, give antihistamine and dexamethasone
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18
Q

How should extravasation of chemo agents be managed?

A
  • Serious!* can need amputation
  • leave catheter in place, attempt to withdraw as much as possible
  • doxorubicin ICE
  • vincristine HEAT
    > specific drugs can be given under specialist advice
  • doxorubicin: dexrazoxane IV
  • vincristine: hyaluronidase locally
    > antiinflam doses of dex IV and topical steroid cream
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19
Q

For dogs with multicentric lymphoma, How does remission rate compare for no tx, pred only, COP and CHOP?

A
  • n/a
  • 33%
  • 70-80%
  • 80-94%
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20
Q

For dogs with multicentric lymphoma, How does first remission duration compare for no tx, pred only, COP and CHOP?

A
  • n/a
  • 1mo
  • 3-6mo
  • 9mo
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21
Q

For dogs with multicentric lymphoma, How does survival time compare for no tx, pred only, COP and CHOP?

22
Q

For cats with high grade lymphoma, how does remission rate compare for no tx, pred only, COP and CHOP?

Study These Flashcards
A
  • n/a
  • n/a
  • 50-80%
  • 50-70%
23
Q

For cats with high grade lymphoma, how does first remission time compare for no tx, pred only, COP and CHOP?

Study These Flashcards
A
  • n/a
  • n/a
  • 3-8mo
  • 4mo
24
Q

For cats with high grade lymphoma, how does survival time compare for no tx, pred only, COP and CHOP?

Study These Flashcards
A
  • 4-6weeks
  • n/a
  • 3-10mo
  • 3-10mo
25
What is the 1 year survival % of cats with high grade lymphoma?
30%
26
What is the 2 year survival rate for dogs with multicentric lymphoma?
20-25%
27
Prognosis for GIT specific lymphoma in cats
``` > low grade - small cell, lymphocytc T cell - good prog - chlorambucil and prednisolone - 70% complete response, MST >2year > high grade - lymphoblastic B or Large T cell shorter MST 3-10mo - large granular lymphocytic (LGL) subtype v poor prog (30% response, MST 1-2mo) ```
28
Prognossis for GIT speicfic lymphoma in dogs
- poor prog (MST ~77d, 6-700 range) | - except colorectal form with longer survival if COP/CHOP used
29
Prognosis for localised nasal lymphoma in cats
- tx radiation : good response | - most respond, MST 1.5-3y in responders
30
Negative prognostic indicators for lymphoma in dogs
- high grade T cell (except one subtype newly discovered with good prog) MST 1/2 that of B cell (ie. 6mo with CHOP) - clinical substage b - Hypercalcaemia (more likely with T cell phenotype) - BM invovlement (stage V) - prolonged pretx with corticosteroids - failure to acheive complete remission - site: GIT/renal/pure hepatosplenic lymphoma
31
Negative prognositc indicators for lymphoma in cats
- failure to acheive complete remission - FELV + status - High grade - LGL (large granular lymphocyte) rare variant
32
What are leukaemias?
- malignant neoplasia originating from haematopoietic precursor cells in BM (or sometimes spleen) - neoplastic cells MAY be present in circulation - sometime proliferate in BM but do not spill out so only cytopenias sen (ALEUKAEMIC LEUKAEMIA)
33
What are the 2 main categories of leukameias?
- lymphoid v myeloid | - acute v chronic
34
What is acute leukaemia characterised by?
- aggressive biological behaviour - dz progression rapid with severe clinical signs - immature blast cells in marrow.blood, poorly differentiated, high capacity for rapid cell division * POOR PROG*
35
What is chronic leukaemia characterised by>
- slow progression - clinical signs mild or incidental finding - neoplastic cells well differentiated late precursor cells, with lesser capactiy for division - *PROG REASONABLE*
36
What are the 2 forms of lymphoid leukaemia?
ALL and CLL
37
Which form of lymphoid leukaemia is not easily differentiated from stage V lymphoma? How do these disease differ? How can they be differentiated?
> ALL (disease starts in the marrow) - sicker - more profound cytopenia on haem - milder lymphadenomegaly > lymphoma (disease starts peripherally and spreads to marrow) - to differentiate use flow cytometry (ALL cells + for CD34 marker of immature haematopoietic stem cells)
38
Which has a worse prognosis, ALL or stage V lymphoma?
ALL
39
What are myeloproliferative disorders?
- neoplastic AND pre-/non-neoplastic conditions of all the non-lymphoid cells in the marrow - uncommon and not well hcaracterised in dogs and cats > acute myeloid leukaemias: undifferentiated leuk, myeloblastic leuk, myelomonocytic leuk, monoblastic leuk, megakaryoytic leuk, erythroleuk, subtypes > myeloproliferative neoplsms/chronic myeloproliferative disorders: chronic myelogenous leukaemia, eosinophilic and basophilic leuk, 1* thrombocytosis (essential thrombocythemia, polycythaemia vera) > others: myelofibrosis, myeoldysplasia
40
Clinical signs of leukaemia?
- non specific wt loss, lethargy, malaise, anorexia, GI signs, mild generalised lymphadenopathy, hepatosplenomegaly - signs related to myelopthisis - fever, petechial haemorrhage, pallor, +- hypercalcaemia
41
How can leukaemias be diagnosed?
- if abnormal cells circulating flow cytometry distinguishes particular cellt ype invovled - may require BM aspirate +- core
42
Tx acute leukaemias. Px?
> poor response rate and px (ALL: 30% response, MST 120d in dogs, response same in cats remission may last longer) > AML similar px - pre-existing cytopenias cause problems as chemo drugs myelosuppressive ^ risk sepsis/haemorrhage > Tx ALL : potentially use same drugs as lymphoma - start with L-asparaginase and pred as less myelosuppressive > Tx AML - try cytosine arabinoside (no one knows how to tx this!)
43
Tx chronci leukaemias? Px?
``` > much better success rate and px! > CLL : affects older animals, - tx chlorambucil and pred (MST 1-3yrs) > CML : rare - tx hydroxycarbamide (hydroxyurea) - MST 4-15months ```
44
What is myeloma?
plasma cell tumour affecting BM in older animals
45
Clinical signs of myeloma. Dx tests and results seen...
- mild pyrexia, lethargy, palor - mild generalised lymphadenopathy - hepatosplenomegaly - signs of hyperviscosity (eg. neuro, retinal detachment, bleeding tendencies, lameness/bone pain d/t lytic lesions in bone esp flat bones) > haem: mild non-regenerative anaemia, cytopenia > biochem: hyperglobulinaemia d/t Ab production by plasma cells (monoclonal spike on serum protein electrophoresis +- hypercalcaemia > radiographs: punched osteolytic lesions (vertebrae, pelvis, long bones) uncommon in cats, or diffuse osteopenia > urine: bencejones light chains proteinuria/ similar pattern to serum if electrophoresis carreid out
46
How can myeloma be dx?
BM aspirate/biopsy showing increased numbers of plasma cells
47
Tx myeloma?
DOGS - Melphalan and prednisolone (MST ~12-18mo dogs) | CATS - Melphalan -> marked myelosuppression so use chlorambucil and prenisolone
48
Px myeloma?
Worse in cats | MST 12-18mo in dogs
49
What is polycythaemia vera?
1* erythrocytosis | - proliferation of erythroid cell series in marrow, with differentiation to RBCs
50
CLiical signs of polycythaemia vera? DDx?
- bright red MMs - neuro signs d/t hyperviscosity of blood - persistently high PCV (65-85%) + low/normal EPO activity > Ddx - differnetiate from dehydration - appropriate causes of ^ PCV (hypoxia) - EPO producing tumours
51
Tx polycythaemia vera?
- phlebotomies - replacment of blood with colloids/electrolytes to alleviate hyperviscosity - hydroxycarbamide (hydroxyurea)

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