LOP rescue protocol for Canine multi-centric T cell lymphoma

RE: LOP rescue protocol for Canine multi-centric T cell lymphoma

Rodney Ayl — Mon, 19 Sep 2022 11:59:41 GMT

Hi, what do you do with the Pred will be determined by what happens with the calcium. If the chemo takes care of the lymphoma and the calcium comes under control, then it is a repeating cycle of daily going to every other day, and then repeating that in the next cycle, if the calcium does not come under control it is probably beneficial to split the dose of 20 mg/m² daily to 10 mg/m² twice daily. In order to try to control the calcium. Hope that makes sense. Kind regards RODNEY.

RE: LOP rescue protocol for Canine multi-centric T cell lymphoma

Sara Ramsey — Sun, 18 Sep 2022 19:22:45 GMT

Thank you very much for this detailed reply. I understand this is a guide and actually, the decision making and client communication is the most challenging part in these cases.

One question: do we stay on EOD pred for the second cycle or go back to SID for the first week again?

We have started the above regime on the 16th and fingers crossed he will achieve another remission.

His blood work showed a mild anaemia (HCT 24%) and his ionised calcium was elevated again - I hope the prednisolone will reduce this.

RE: LOP rescue protocol for Canine multi-centric T cell lymphoma

Rodney Ayl — Wed, 14 Sep 2022 17:05:17 GMT

Hi,

This is a Modified LOPP Protocol and is more conservative than the original one.

LOPP (Mostly used for T-cell lymphomas) 4 week cycle
Day 1: Vincristine 0.4-0.6 mg/m² IV.
Day 14: Lomustine: 40-60 mg/m² PO.
Day 1-14: Procarbazine 50mg/m2 PO SID x14 days. For dogs <0.4m2 use 50mg EOD
Day 1-28: Prednisolone: 20 mg/m² PO SID x 1 week, then 20 mg/m² PO EOD.
Length: up to 6 months is possible. Each cycle: 4 weeks.

It is important to consider a chemo protocol as a guide and not a recipe.

New decisions should be made with every treatment based on tolerance of the patient and response of the tumour, in that order.

As the protocol is conservative I generally don't do NADIR testing, and just test on the day of treatment.

You will need to follow a chemistry for the lomustine treatment, monitoring liver and kidney values.

You will need to be careful with a pre-treated dog as the pet may have a poor bone marrow reserve at this stage, and not be able to handle myelosuppressive drugs.

I recommend starting at the low end of the doses for the first cycle, and then dose escalate if well tolerated.

I would recommend working with an oncologist if possible, as these rescues can become very complicated.

Hope that helps! Good luck!

Kind regards,

Rodney Ayl