Chronic lymphocytic leukaemia

Re: Chronic lymphocytic leukaemia

Bob Russell — Thu, 26 Feb 2015 15:22:50 GMT

Yet another update (because I am feeling a little pleased with myself). Clinically pretty much normal, still skinny but lymphocyte count dropped from 70 x 10^9 before treatment, now 8 x 10^9.

Re: Chronic lymphocytic leukaemia

Bob Russell — Fri, 13 Feb 2015 12:00:55 GMT

Seen 1 week after starting preds and chlorambucil. We decided to go for it!

'Horrible' abdomen is almost back to 'normal'. No obvious masses evident on palpation. Much brighter and happier. Hat-rack thin but eating like a horse!

Owner is aware the prognosis is very guarded but I have to admit I am amazed at the clinical improvement over a few days. One minor episode of diarrhoea the only adverse reaction.

So far much better than expected!

Re: Chronic lymphocytic leukaemia

Hannah Wynne Richards — Fri, 06 Feb 2015 14:42:19 GMT

All I can add to that is good luck.

Wynne

Re: Chronic lymphocytic leukaemia

Gerry Polton — Fri, 06 Feb 2015 13:13:46 GMT

I must tell you that I have seen two cases of marked lymphocytosis (~70,000/microlitre) in young springer spaniels which were thought to be CLL but which proved to be self-resolving. Goodness only knows what they had. Both had been vaccinated in the preceding two months but then so have approximately one sixth of the vaccine-consuming pet population so who knows...

Gerry

Re: Chronic lymphocytic leukaemia

Bob Russell — Fri, 06 Feb 2015 12:19:43 GMT

We have performed FNA's on enlarged LN's and excision biopsy of same - come back as reactive lymph nodes without clear neoplasia. The liver is grossly enlarged and excessive abdominal fluid is present. Not a happy abdomen but the owner has decided not to go for referral despite recommendations. Everything clinically looks dodgy but the owners are aware that we have not got a full picture. They also know the prognosis is very guarded.

Much as I would like to do more it is a rock and hard place situation.

We are going to lose the dog anyway and options are to treat or not treat. As always it is a very nice dog, nice owners and insurance was cancelled when the dog went to live with the daughter!

One of the most frustrating cases but I am reluctant to just give up!

Many thanks!!!

Re: Chronic lymphocytic leukaemia

Gerry Polton — Fri, 06 Feb 2015 11:01:21 GMT

Hi Bob

This doesn't sound straightforward to me. As a rule CLL cases have only very mild peripheral lymphadenopathy. Cytopenias are not expected on routine CBC. I think you may have a small B cell lymphoma with bone marrow invasion which would carry a much worse prognosis. I couldn't advise on treatment without knowing more and realistically probably seeing the case but I agree with you completely that this does not fit the CLL mould. I would urge you to undertake more complete staging to better understand what is going on here: ultrasound abdomen, aspirate liver and spleen if they look dodgy, and most importantly, sample the bone marrow.

Best of luck with it

Gerry