alimentary lymphoma in cats

Re: alimentary lymphoma in cats

Martin Atkinson — Fri, 24 Apr 2015 14:15:02 GMT

[quote user="Kate Richardson"]...the original diagnosis was Dec 2012[/quote]I didn't spot that date. It does seem unlikely that a true alimentary lymphoma would have gone two and a half years without regression.

As Dr Sam Ryan said in Silent Witness when faced with an apparent miracle cure of cancer with Holy Water: 'I would prefer to question the original diagnosis'.

Re: alimentary lymphoma in cats

Kate Richardson — Fri, 24 Apr 2015 14:03:21 GMT

I think I would be tempted to do some FNAs as the original diagnosis was Dec 2012 just to be a bit more certain still dealing with lymphoma and not something else?

Re: alimentary lymphoma in cats

Gerry Polton — Fri, 24 Apr 2015 13:47:53 GMT

Hi Kerry

If this is different now from how the cat originally presented (big lymph nodes and thickened bowel versus normal bowel thickness and no lymphadenopathy for example) then I would definitely change to COP. If it appears pretty much the same as it always did, then your own suggestion of an altered treatment protocol would perhaps be better, with COP being rolled out at a later date when required. The altered treatment I would probably go for is 2mg chlorambucil once every second day. You have a higher chance of treatment-induced complications than you did with the 4mg chlorambucil q14d strategy. The principal problem encountered is myelosuppression. Neutrophils usually recover quickly, platelets do not.

The question that has not yet been asked is whether it is OK to assume this cat is suffering a progression of the lymphoma at all. I don't know the right answer. However, I will offer my answer which is that I am pretty sure that I would proceed as if I did know for sure that this was a relapse of the lymphoma. Without direct experience of a case it's always hard to be sure about what I would do in tricky situations like this. It is worth bearing in mind though that, as you said, this cat is on a fairly high dose of predisolone and presumably has been for some time. There could be an infectious process here and the lymphoma could be still very nicely under control. I would be interested to know everybody's opinions on this. The textbook answer would be that you have to re-biopsy, but with an indolent lymphoma as this must have once been, cytology is unlikely to yield a definitive answer if lymphoma is the underlying reason.

It's always fun and interesting to discuss these cases. Thanks, Kerry, and good luck with it.

Gerry

Re: alimentary lymphoma in cats

Martin Atkinson — Fri, 24 Apr 2015 13:28:34 GMT

I have always treated my cases with COP and had thought of switching to chlorambucil. However, on the advice of His Gerryness I reverted to COP. Cats tolerate it well, you can give 50mg cyclophosphamide every second week (or you can get reformulated lower doses from NDSR at a price) and don't get the side effects you may see in dogs. Last one I treated on this regime lived for 9 months post diagnosis.

However, knowing Gerry he will be along soon and will have some new fangled drug or changed his mind but cest' la vie.

Re: alimentary lymphoma in cats

Francisco Gomez — Thu, 23 Apr 2015 20:59:49 GMT

Just waiting to be shot I guess... Are we allowed to add an antibiotic with this sort of neutrophilia? Or maybe you are already using one?