Haematopoetic Neoplasia 2 (Annaleise Stell) Flashcards Preview

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Flashcards in Haematopoetic Neoplasia 2 (Annaleise Stell) Deck (51)
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Most effective general type of tx for lymphoma

- 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.


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

> 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


Is chemo curative for lymphoma?

No remission not cure, will relapse


What protocol are available for tx lymphoma?

- cyclophosphamide , vincristine, prednisolone
- induction phase + ongoing oral maintainance (chlorambucil, methotrexate, prednisolone)
- doxorubicin containing
- more intensive initially, longer induction
- no maintainance
- 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


What adverse effects may lomustine have?

hepatotoxic so monitor SAMe


Which cat lymphomas is cytosine arabinoside useful for?

- renal
- CNS (cytarabine crosses BBB)


Standard maintainance for cats

- chlorambucil and prednisolone EOD


How is low grade feline GI lymphoma tx?

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


Outline a low budget protocol for tx lymphoma

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


How can lymphoma relapses be tx?

- 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


Are resuce tx often successful?

Less successful than 1* induction


How can hypercalcaEMIA BE MANAGED?

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


6 methods of monitoring lymphoma patients on chemo

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


How can GI disturbance d/t chemo be managed?

- 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+


How can myelosupression d/t chemo be managed?

- prophylactic Abx if neutrophils


How can haemorrhagic cystitis d/t cyclophosphamide be managed?

- 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


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

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


How should extravasation of chemo agents be managed?

* 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


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

- n/a
- 33%
- 70-80%
- 80-94%


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

- n/a
- 1mo
- 3-6mo
- 9mo


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



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

- n/a
- n/a
- 50-80%
- 50-70%


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

- n/a
- n/a
- 3-8mo
- 4mo


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

- 4-6weeks
- n/a
- 3-10mo
- 3-10mo


What is the 1 year survival % of cats with high grade lymphoma?



What is the 2 year survival rate for dogs with multicentric lymphoma?



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)


Prognossis for GIT speicfic lymphoma in dogs

- poor prog (MST ~77d, 6-700 range)
- except colorectal form with longer survival if COP/CHOP used


Prognosis for localised nasal lymphoma in cats

- tx radiation : good response
- most respond, MST 1.5-3y in responders


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