Lymphoma and pred

Re: Lymphoma and pred

Martin Atkinson — Tue, 21 Aug 2012 12:28:47 GMT

[quote user="Thomas Johnson"] discussed a multicentric lymphoma case with Gerry Polton at NDSR recently, the owners were considering chemo at that point but eventually decided against. His recommendation if giving just pred was to start at 0.5mg/kg sid when the dog was unwell, and increase if not having the desired effect. [/quote] My initial response was to say 40mg/Msq which is a bit over 1mg/kg but if Gerry rrecommends the above I would go with it. Gerry Polton walks on water!

Re: Lymphoma and pred

Lucy Fleming — Tue, 21 Aug 2012 11:33:32 GMT

My understanding is that survival times on pred alone are not significantly different to untreated cases (though I agree the info is sparse) - but hopefully the quality of life is improved for that remaining time. That's the way I've stressed it to the owners anyway. Currently both dogs are reportedly improved on pred...fingers crossed.

Re: Lymphoma and pred

plantagenet — Sat, 18 Aug 2012 17:21:13 GMT

2 months seems to be the expected and gives the owner a bit of breathing space.

Re: Lymphoma and pred

Busybee — Sat, 18 Aug 2012 13:34:29 GMT

[quote user="Charlotte Marshall"]What is average survival on preds only? When I tried to find information on survival times without treatment or with preds only for a case report I could not find any papers. The only papers I could find compared different chemotherapy regimes.[/quote]

I remember being told it was around 3 months . Both of my cases lived 2 months.

Re: Lymphoma and pred

Bob Russell — Sat, 18 Aug 2012 09:35:14 GMT

[quote user="Charlotte Marshall"]

What is average survival on preds only? When I tried to find information on survival times without treatment or with preds only for a case report I could not find any papers. The only papers I could find compared different chemotherapy regimes.

[/quote]

No idea of true averages but mine seem to do well for a couple of months then deteriorate rapidly.

Re: Lymphoma and pred

Charlotte Marshall — Fri, 17 Aug 2012 19:53:44 GMT

Re: Lymphoma and pred

Thomas Johnson — Fri, 17 Aug 2012 19:07:32 GMT

I discussed a multicentric lymphoma case with Gerry Polton at NDSR recently, the owners were considering chemo at that point but eventually decided against. His recommendation if giving just pred was to start at 0.5mg/kg sid when the dog was unwell, and increase if not having the desired effect.

My case was not unwell, so no treatment intially, a month later the lymph nodes increased in size dramatically and the dog developed submandibular pitting oedema, I started pred at 0.5mg sid. I saw the dog yesterday, 3 months after starting pred, and the lymph nodes are only marginally bigger than normal.

I know that the dog is doing much better than average for survival, but I will be starting future cases that elect not to have chemo on 0.5mg/kg sid.

Re: Lymphoma and pred

Busybee — Thu, 16 Aug 2012 21:51:13 GMT

I've had two recently - both dogs with multicentric lymphoma. One not given chemo due to costs, one because of the nature of the dog. I had a very useful conversation with a gentleman at the AHT before the first one I had with regards to treatment options. We did come up with a pretty good oral-only chemo protocol but this again was rejected on cost-grounds. So both ended up on pred-alone. Both were started on 2mg/kg divided into two daily doses for the first week then dropped to 1mg/kg again divided into two daily doses. Think both lasted about 2 months (median survival time quoted as 3months).

As said above, it's important to manage owner expectations. What is important to them is the expected survival time and the quality of life the animal has left as well as costs involved. Also stress to the owner that once you start a pred-only protocol, you can't easily switch to chemo which some owners can be tempted to do if the dog responds very well to the pred.

Also have a look here - http://www.vetsurgeon.org/forums/t/11649.aspx?PageIndex=1

Re: Lymphoma and pred

Rajat — Thu, 16 Aug 2012 20:05:13 GMT

Hi Lucy

I use a bit higher dose than that for first 4 weeks or so (or till tolerated) then a very slow taper to at or just under 1mg/kg.

To get the anti tumour effect you may need close to 2mg/kg. At least that was my understanding. I find higher incidence of s/e over 2mg/kg though and it p**es many people off that one has just given their terminally ill dog with just a coupla months to live incontinence panting and permanent hunger..!

Best

Raj

Re: Lymphoma and pred

Lucy Fleming — Thu, 16 Aug 2012 11:12:39 GMT

thanks everyone...I think I have managed the owner expectations well regarding it being palliative care, expected survival times etc though you never know exactly what they have chosen to hear!

Re: Lymphoma and pred

Hannah Wynne Richards — Thu, 16 Aug 2012 10:38:15 GMT

The steroid high can fool the owner into thinking it's a cure-with a worse let-down after

Wynne

Re: Lymphoma and pred

Bob Russell — Thu, 16 Aug 2012 10:10:57 GMT

We have just lost a GSD (father of our dog) as a result of lymphoma. The owner decided to treat with preds only. The dogs quality of life improved dramatically and he lasted a couple of good quality months.

If this is the only available option it is worth going down this route but be careful to manage the owners expectations especially if the dog seems dramatically improved!

Re: Lymphoma and pred

Hannah Wynne Richards — Thu, 16 Aug 2012 09:59:07 GMT

Keep on maximum dose which doesn't produce side effects-the original problem isn't going away-very mild compared to proper chemo-but can give useful prolongation of life

Wynne