L Asparaginase

Re: L Asparaginase

Thomas Johnson — Mon, 16 Feb 2015 12:03:59 GMT

[quote user="Bob Russell"]

Strange that lymphoma treatment with L Asparaginase works so well in Japan. I wonder if they have a different type of lymphoma to the ones I see?

[/quote]

Could the genetic make-up of dogs in Japan be different enough from dogs in the UK that there are differences in the lymphomas seen and/or their sensitivity to L Asparginase?

Re: L Asparaginase

Bob Russell — Mon, 16 Feb 2015 09:32:23 GMT

There is a big difference between the weekly (or less infrequent) and monthly dosing. The owners have already accepted that the dog has already done better than was expected.

I will go with monthly treatment unless he starts to deteriorate significantly before then.

Strange that lymphoma treatment with L Asparaginase works so well in Japan. I wonder if they have a different type of lymphoma to the ones I see?

We pre-treated with piriton with the first dose but will admit the dog for the day when we give the second dose.

I hate peanut butter and one mouthful would be more than enough for me!

Thanks for the advice. I will post updates, good or bad!

Re: L Asparaginase

Gerry Polton — Mon, 16 Feb 2015 08:58:55 GMT

Hi All

This is one of those (many) areas where it is impossible to wade through the dogma to reach the actual science. Convention states that the product is used twice at a four week interval. Some people use it three times. The risk of anaphylaxis is grossly overstated... unless it happens. Did you know that every slice of toast with peanut butter shortens your life by five minutes? Of course it doesn't really but if you take a mean of the life expectancy impact of peanut butter across a whole population it works out that peanut butter does actually send you into an early grave, on average. I think a similar story could be thought to be applicable here.

Amusingly, in Japan, they regularly treat some dogs with multicentric lymphoma with L-asparaginase alone. I attended one presentation where the median life expectancy with L-asparaginase alone was in excess of one year. It doesn't work that well over here, I can promise you. But the story illustrates the point that we practice medicine by culture as much as by science.

I will add, that it is OK, in fact good, to recognise that we practice by culture but it is another thing then unilaterally decide that said culture is wrong and to go rogue!

Back to the case. If you have something that works, keep using it! However, you have to be aware of the risks, and anaphylaxis is certainly one of them. I would keep the patient under your care for a number of hours before releasing it and I would school the owner in recognition of delayed hypersensitivity reactions and what to do in the event that they happen.

Please let us all know what happens

Gerry

Re: L Asparaginase

Virginia Campbell — Sat, 14 Feb 2015 14:36:11 GMT

I gave my one and only epitheliotrophic lymphoma case this, when the yukky ulcerated masses started bouncing up after a period of remission with lomustine and pred.

Got, as far as I remember, 3 treatments at weekly intervals, didn't do any good, euthansed dog (though in fairness to the aspiraginase, dog only got it when there were multiple big lumps, some ulcerated).

No undesirable SEs except it stings!!

Your owners must have deep pockets/high insurance limit to be considering doing at weekly intervals ongoing though....

Have used it in one other case, a "normal" lymphoma which had relapsed despite being on COP protocol...didn't manage to rescue it and euthed after 2 treatments but again, not really a fair crack of the whip for the drug. Again no SEs apart from the stinginess.

Re: L Asparaginase

Bob Russell — Sat, 14 Feb 2015 10:06:53 GMT

There seems to be relatively little documented regarding epitheliotropic lymphoma. I am not claiming long term benefits for this dog but can say, without any hesitation that it has worked a miracle so far!

A patch the size of a side plate developed, thickened and stinking and within a week it has become a pink, painless and odourless area 10x5cms. There has not been any other changes to medication.

Logic would suggest hit the cells hard at weekly or so intervals, accepting the risk of adverse reactions but one of the local medicine specialists suggests monthly..

Re: L Asparaginase

Martin Atkinson — Fri, 13 Feb 2015 14:13:08 GMT

I think this is one for Gerry if he's back from skiing but a lot of people reckon asparaginase is of limited benefit. However I've used it as part of a modified Madison protocol in a dog with non-lymphocentric lymphoma. Dosage was 10,000iu/msq at week 7, 8 and 9 and it is the only one that survived and is indeed still alive over 4 years later.