CHOP protocol for lymphoma

Re: CHOP protocol for lymphoma

Martin Atkinson — Thu, 28 Jul 2011 11:48:22 GMT

Depnds on how bad the GI effect is. If it is HGE that required IV fluids and intensive treatment then I'd stop, if it was just moderately severe I'd continue. As mentioned in a previous post on this thread in one case I stopped after 2 doses and didn't substitute with anything else and dog is still alive well over 2 years later with no recurrence but it did have l-asparaginase in the mix.

Re: CHOP protocol for lymphoma

Laura Atkinson — Thu, 28 Jul 2011 11:11:49 GMT

Yes good point. The reference I am using suggests stopping at week 11, rather than continuing till 19 weeks so that was the reason for my post.

Re: CHOP protocol for lymphoma

Laura Atkinson — Thu, 28 Jul 2011 10:21:19 GMT

Out of interest what does everyone do after doxo Gi side effects? Do you leave it out next time and substitute another drug or just reduce the dose?

Re: CHOP protocol for lymphoma

Andrew Kent — Mon, 25 Jul 2011 22:12:19 GMT

I have found no difference myself between using asparaginase and not but find the doxorubicin/epirubicin makes the big difference - I do use asparaginase when restarting protocol in relapsed cases. We all have different anecdotal experiences!

Re: CHOP protocol for lymphoma

Martin Atkinson — Mon, 25 Jul 2011 16:10:47 GMT

I read that article and wasn't convinced. It may be anecdotal but the CHOP (sans asparaginase) protocols I tried previously resulted in no better remission times than COP i.e 6-12 months. The last one on a modified Madison protocol with asparaginase is still alive over 2 years later (OK clearly not statistically significant). If anything I'd drop the Doxorubicin as it seems to have the worst side effects: 1 dog dead from heart failure, 1 gastric torsion possibly due to GI effects?, several cases of GI disease so severe I had to stop it including the one on asparaginase that's still alive. Asparaginase may be expensive but it can be given s/c so much lower hospitalisation costs.

Re: CHOP protocol for lymphoma

Rob Loxley — Mon, 25 Jul 2011 13:47:53 GMT

There's an interesting study from JVIM suggesting that leaving l-asp out of CHOP doesn't influence outcome. And l-asp is pretty costly.

Re: CHOP protocol for lymphoma

Martin Atkinson — Mon, 25 Jul 2011 10:52:30 GMT

They are generally in clinical remission after the first week so why not stop then?! There is no logic in stopping at any point other than the recommended end of the course unless the patient is intolerant or it plainly isn't working. I would also do a 26/27 week protocol but mine also throws in l-asparaginase into the mix. The last one I did the dog was in complete remission at the end and I continued with the preds every other day. One we got past 18 months I began to wonder if there was any need to continue but as there is precious little data on dogs surviving beyond this time I did. It is now 54 months in remission and after having spoken to Jerry Polton, we consider it is probably 'cured' and have stopped all medication.

Re: CHOP protocol for lymphoma

Laura Atkinson — Sun, 24 Jul 2011 16:06:25 GMT

Thanks Andy.

Re: CHOP protocol for lymphoma

Andrew Kent — Fri, 22 Jul 2011 21:23:23 GMT

I usually follow either a 19 week or 26 week protocol, they are very similar in terms of numbers of treatments but the 19 is a little more intensive. As far as I am aware there isn't any difference between outcomes of these two. I have never done an 11 week protocol but my instinct would be this is a little short.

I would not worry about repeating imaging at this stage unless clinical indication of failure of treatment.

Andy