lymphoma protocol

Re: lymphoma protocol

Christopher Saul — Fri, 02 Mar 2012 15:35:22 GMT

Will do, if I ever get it finished instead of wasting time, ahem, broadening my knowledge on here

To answer David's original question .....

[quote user="David Mills"] Anyone have a useful, efficacious outpatient (i.e. oral) protocol [/quote]

Simple answer: When cost is a major issue, the only cheap(ish) option is chorambucil and pred as Chris B has already suggested. (though I generally feel uncomfortable sending owners home with cytotoxics; I have the dog in briefly to pill them myself)

Strictly speaking the chlroambucil/pred protocol is described for feline small cell gasrointestinal lymphoma rather than for muticentric lymphoma, but even so it is a recognised lymphoma protocol if you see what I mean. In addition, chlorambucil is relatively inexpensive and less likely to cause horrific side effects than other cytotoxics.

Lomustime/CCNU is not only expensive but is also very myelosupressive and requires fairly intensive monitoring of CBC etc. Having said that it's the only thing that touches epithelioptrophic lymphoma in my experience

Hope this helps

Chris

Re: lymphoma protocol

HMC — Fri, 02 Mar 2012 13:46:29 GMT

[quote user="Christopher Saul"]I am doing a study myself into this, I hope to publish the results in the next few months[/quote]

Please let us know where and when you publish this. I'm sure many of us would be interested to see your conclusions.

Re: lymphoma protocol

Christopher Saul — Fri, 02 Mar 2012 11:38:06 GMT

[quote user="Clive Ansell"]

What are the success rates of various chemotherapy drugs vs just good old prednisolone anyway?

[/quote]

An interesting question to which there isn't a single answer.... Partly because there isn't a single standard chemo protocol (even amongst referral clinicians there is significant variation as to which exact protocols are used; I am doing a study myself into this, I hope to publish the results in the next few months), partly because the published data are based upon small numbers of animals, but mainly IMHO the term 'lymphoma' probhably encompasses a large group of different diseases that we (as in the world of veterinary medicine) have yet to define, and I mean far more than just the T and B cell division.

Depending on which studies you read, quoted median remission times for doxorubicin based multiple drug protocols are generally in the region of 9-12 months with survival times in the region of 12-17 months. Compare this with prednisolone alone, with a median survival times of maybe 3 months.

However, within each treatment group there will generally be a vast range of remission and survival times between individuals, and there will usually be a small cohort of patients who may stay in remission for much longer ( greater than 2 years) , and also a small cohort of patints who will survive for much shorter than quoted survival times. Even within my own personal experience I have treated one patient who had a remission of 3 years (that one was on a COP) and another of just 2 months (that was on a variation on CHOP). I have once seen ( not a patient of my own) a dog who survived for 7 months on pred alone, so if you happened to have one of these extended survivors amongst your first lymphoma patients , you'd probhably think that whichever protocol you used was the best one, but in reality the reason for this probhably had more to do with the disease than the choice of protocol.

In summary, there is alot of evidence that doxorubicin/vincristine/cyclophos based protocols are associated with the longest average remission and survival times, though in reality - as with choosing an anaesthetic regime - the safest choice is the choice you are most comfortable with. Remember these drugs are nasty; they have a high potential for side effects and they are dangerous from a health and safety point of view, so for instance if you aren't comfortable administering doxorubicin I wouldn't do it.

Chris

Re: lymphoma protocol

Martin Atkinson — Fri, 02 Mar 2012 11:10:50 GMT

[quote user="Chris Barker"]

I shall tell the owners of the Staffie that your notes state that it doesn t work My experience in this and other cases is that it does That s book learning for you I suppose

[/quote]

I presume this was aimed at me Chris although you haven't quoted so can't be sure. Given the flavour of this thread: that you can't compare like for like as the type of lymphoma and response to therapy is variable, with some people claiming as good response with just preds as full -on chemo and that you got your protocol from Nelson and Cuto (erm...book learning is it not?), Laura Blackwood's opinion is as valuable - that was not from standard text but from CPD lectures and her experience. I can claim a complete cure (dog in remission three and a half years) with a modified Wisconsin-Madison protocol - would it have done as well with just preds or something else much simpler? I don't know.

Re: lymphoma protocol

Simon Neuhoff — Fri, 02 Mar 2012 10:56:16 GMT

[quote user="Charlotte Marshall"]

I tried to find this out for a case study I wrote and I could not find any data. In reports comparing chemotherapy regimes they did not give survival times for animals which did not receive chemotherapy either.

However my experience in practice is there is an overlap. I have seen dogs on prednisolone alone survive for longer than animals on chemo. I do not know however which were B and which were T cell lymphomas which would have a big impact on survival times.

[/quote]

From my very limited, GP type knowledge I think this is the crux. Are we comparing apples with apples? As I understand it some individuals survive very nicely with no treatment at all - I have certainly seen 6 months survival in a dog given nothing whatsoever (this one confirmed histopatholigically as a lymphoma but not typed due to costs). I have also read something which implied that the site of the lymphoma also affected outcomes. Given all this comparing treatment regimes accurately seems pretty difficult.

Re: lymphoma protocol

Charlotte Marshall — Thu, 01 Mar 2012 21:47:05 GMT

Re: lymphoma protocol

Clive Ansell — Thu, 01 Mar 2012 20:43:50 GMT

What are the success rates of various chemotherapy drugs vs just good old prednisolone anyway?

Re: lymphoma protocol

Rob Loxley — Thu, 01 Mar 2012 20:08:26 GMT

[quote user="Chris Barker"]I shall tell the owners of the Staffie that your notes state that it doesn t work My experience in this and other cases is that it does That s book learning for you I suppose[/quote]

You say it is as successful as prednisolone alone, is chlorambucil and pred any better than prednisolone alone (I don't know the answer) for lymphoma?

Re: lymphoma protocol

Chris Barker — Thu, 01 Mar 2012 20:03:51 GMT

I shall tell the owners of the Staffie that your notes state that it doesn t work My experience in this and other cases is that it does That s book learning for you I suppose

Re: lymphoma protocol

Martin Atkinson — Thu, 01 Mar 2012 18:48:36 GMT

[quote user="Chris Barker"] plus Chlorambucil (Leukeran) 20mg/m2 once every 2 weeks[/quote] In my oncology notes (Laura Blackwood, Glasgow Uni) it states chlorambucil is not suitable for induction but can be used for maintenance 5-10mg/Msq eod if the patient gets sterile cystitis or too much myelosuppression from the cyclophosphamide. Cyclophosphamide dose would be 50mg/msq eod or 4 dys on 3 dys off but titrate dose for time rather than pill size as you shouldn't split the tablets so say calculate dose over 2 weeks and divide eg a 3.6kg cat would have one 50mg tablet every 10 days. Could try Melphalan 5mg/Msq eod but may get more bone marrow suppression than with cyclophosphamide and advise giving antacid. At least they're all cheap.

Re: lymphoma protocol

Chris Barker — Thu, 01 Mar 2012 18:29:23 GMT

Tablet only protocol as per Nelson and Couto

Prednisolone 50mg/m2 sid for 7 days, then 25mg/m2 eod plus Chlorambucil (Leukeran) 20mg/m2 once every 2 weeks

In our hands as sucessful as Prednisolone alone and have just euthanased a Staffie which we maintained for 8 months since diagnosis

Re: lymphoma protocol

Martin Atkinson — Thu, 01 Mar 2012 17:52:12 GMT

All I could suggest is cyclophosphamide and prednisolone so COP protocol without the O. Chlorambucil may be useful as a maintenance but is no use for induction. I guess Lomustine is out of the question?

Re: lymphoma protocol

Clive Ansell — Thu, 01 Mar 2012 17:32:35 GMT

In the charity clinics and PetAid practices I work, it is prednisolone or prednisolone. I think it works as well, or almost as well, as chemotherapy protocols and is considerably cheaper (and safer?).