Re: High grade lymphoma right kidney

Christopher Saul — Tue, 12 Aug 2014 23:35:52 GMT

[quote user="Martin Atkinson"]You are being very philosophical today Gerry. [/quote]

Gerry's always philosophical Martin, but in a good way

Re: High grade lymphoma right kidney

Martin Atkinson — Fri, 08 Aug 2014 09:29:21 GMT

[quote user="Robin Grimmer"]

Doesn't renal lymphoma carry a worse prognosis than other forms of lymphoma, eg multi centric? As the owner is an old lady with financial difficulties, preds alone maybe?

[/quote]My limited experience with lymphoma is a single organ is the opposite - a longer term response but that may just be luck of the draw as none of them have been typed.

As for cost, the actual ingredients of COP are cheap, especially if you re-use the vincristine vial (don't tell VMB or the 'elf and safety boys) it is then down to you how much you want to charge the old dear for your time and occasional blood test. Chemo can be a cash cow if you want it to but that depends on the clinician.

Re: High grade lymphoma right kidney

Robin Grimmer — Thu, 07 Aug 2014 22:13:42 GMT

Doesn't renal lymphoma carry a worse prognosis than other forms of lymphoma, eg multi centric? As the owner is an old lady with financial difficulties, preds alone maybe?

Re: High grade lymphoma right kidney

Martin Atkinson — Thu, 07 Aug 2014 18:23:01 GMT

You are being very philosophical today Gerry.

Re: High grade lymphoma right kidney

nelu rudareanu — Thu, 07 Aug 2014 15:57:14 GMT

Thanks Gerry

Re: High grade lymphoma right kidney

Gerry Polton — Thu, 07 Aug 2014 15:13:30 GMT

A-ha! The old, 'What is the best treatment for lymphoma' chestnut!

My stock answer to this question has always been that for an uncomplicated case of 'normal' lymphoma, the best treatment protocol is the one that you and your colleagues agree to use together in your practice. Generally we are talking about one form or another of the COP or CHOP protocol. However, there are as many subtly different versions of these as there are people prepared to express an opinion. Nothing undermines an owner's confidence in a course of chemotherapy more than finding that different staff in their single veterinary practice have different opinions about what is the right treatment for their cat or dog. And chemotherapy is a very emotive thing. However, simple we think our patients' journeys through their chemo protocols are, our owners worry and they worry a lot every day that their pet is still receiving treatment. In order to manage chemotherapy-associated problems, we need to be familiar with the problems that can arise. The only way to become truly familiar is to care for patients who experience them. We can learn an awful lot quicker if these experiences are shared. If you have colleagues in your practice who are also involved in the adminstration of chemotherapy, ensure that you all talk about any problems, or near problems that may arise.

So, if you want to get the best outcome, the first thing is to ensure that you don't get a disastrous outcome because you and your colleagues have different attitudes towards: the wisdom/kindness of chemo in the first place, the doses and timings or treatments in use, the appropriate response to an adverse event of one kind or another, and the options available should treatment prove unsuccessful. If you are all in agreement in these aspects of care, then your cat or dog will have a good chance of achieving a good and durable response to therapy, whichever therapy you choose.

If you want to change the treatment that you regularly use in your practice, that is fine and for many clinicians that will have to happen at some time. But, choose an uncomplicated case or normal lymphoma if you do that so you can compare your expectations for a normal case with those that you see with your case receiving a different treatment plan. Successful chemotherapy is often about accurately about defining expectations so that owners (and vets) do not worry unduly and do not make rash and irreversible decisions.

To get to the point. If you perform chemotherapy relatively regularly in your practice, use the chemotherapy protocol that you would usually use in a cat with lymphoma for this case. If you do not regularly administer chemotherapy to cats, consider contacting your nearest oncologist and asking what they would choose to treat this cat with and either referring it to them so that you can share the responsibility of care (I imagine you and the oncologist both doing treatments and then commuicating with each other about the cat's progress) or treating the cat using their protocol so that if there are any questions or problems you can ask them for help and they will at least know the treatment plan you are using since they gave it to you in the first place.

If you just want an answer instead of all this opinionated waffle, COP.

Gerry