Page 1314 - Small Animal Internal Medicine, 6th Edition

1286 PART XII Oncology

12 DEX creatinine concentrations or the tumor burden was high; one
ADR of the dogs had high liver enzyme activities. Within 1 to 7
VetBooks.ir 10 days of the start of chemotherapy, lethargy, vomiting, and
bloody diarrhea developed in affected dogs, and the serum
phosphorus concentrations increased markedly (Fig. 77.5).
8
Aggressive fluid therapy and the correction of acid-base and
mg/dL 6 electrolyte disturbances resulted in resolution of the clinical
signs within 3 days in 6 dogs; the remaining 2 dogs died as
a result of ATLS.
4
Suggested Readings
2
Best MP, Fry DR. Incidence of sterile hemorrhagic cystitis in dogs
receiving cyclophosphamide orally for three days without con-
0
–4 –2 0 2 4 6 8 current furosemide as part of a chemotherapeutic treatment for
lymphoma: 57 cases (2007-2012). J Am Vet Med Assoc.
Day
2013;243:1025.
Chan CM, et al. Incidence of sterile hemorrhagic cystitic in
FIG 77.5 tumor-bearing dogs concurrently treated with oral metronomic
Serum phosphorus (Δ), calcium (○ ), and creatinine (□)
concentrations in a dog with acute tumor lysis syndrome cyclophosphamide chemotherapy and furosemide: 55 cases
after chemotherapy for a primary pulmonary lymphoma. (2009-2015). J Am Vet Med Assoc. 2016;249:1408.
Note the increase in the serum phosphorus concentrations, Charney SC, et al. Risk factors for sterile hemorrhagic cystitis in
with a mild decrease in the calcium concentrations and dogs with lymphoma receiving cyclophosphamide with or
minor increases in the serum creatinine concentrations. ADR, without concurrent administration of furosemide: 216 cases
Doxorubicin; DEX, dexamethasone. (From Couto CG: (1990-1996). J Am Vet Med Assoc. 2003;222:1388.
Management of complications of cancer chemotherapy, Vet Couto CG. Management of complications of cancer chemotherapy.
Clin North Am 20:1037, 1990.) Vet Clin N Am. 1990;20:1037.
Hakim H, et al. Gut microbiome composition predicts infection
risk during chemotherapy in children with acute lymphoblastic
veterinary use. Lastly, cisplatin can cause fatal pulmonary leukemia. Clin Infect Dis. 2018;67:541.
hypertension and edema in cats, and for this reason, is con- Harvey HJ, et al. Neurotoxicosis associated with use of 5-fluorouracil
in five dogs and one cat. J Am Vet Med Assoc. 1977;171:277.
traindicated for use in this species.
Hosoya K, et al. Prevalence of elevated alanine transaminase activ-
ity in dogs treated with CCNU (lomustine). Vet Comp Oncol.
2009;7:244.
ACUTE TUMOR LYSIS SYNDROME Kalay N, et al. Protective effects of carvedilol against anthracycline-
induced cardiomyopathy. J Am Coll Cardiol. 2006;48:2258.
In human patients, the rapid lysis of certain tumor cells (e.g., Knapp DW, et al. Cisplatin toxicity in cats. J Vet Intern Med.
lymphoma cells) shortly after chemotherapy may lead to 1988;1:29.
a syndrome of hyperuricemia, hyperphosphatemia, and Kristal O, et al. Hepatotoxicity associated with CCNU (lomustine)
hyperkalemia, either singly or in combination. This clinical chemotherapy in dogs. J Vet Intern Med. 2004;18:75.
entity is referred to as acute tumor lysis syndrome and is Laing EJ, et al. Treatment of cyclophosphamide-induced hemor-
rhagic cystitis in five dogs. J Am Vet Med Assoc. 1988;193:233.
thought to be secondary to the release of high quantities of Mealey KL, Meurs KM. Breed distribution of the ABCB1-1Δ (mul-
intracellular phosphate, uric acid, and nucleic acid metabo- tidrug sensitivity) polymorphism among dogs undergoing
lites. The intracellular concentration of phosphorus in ABCB1 genotyping. J Am Vet Med Assoc. 2008;233:921.
human lymphoma and leukemic cells is 4 to 6 times higher Peterson JL, et al. Acute sterile hemorrhagic cystitis after a single
than that in normal lymphocytes, and the same appears to intravenous administration of cyclophosphamide in three dogs.
be true for dogs. J Am Vet Med Assoc. 1572;201:1992.
In dogs ATLS has been reported to occur only in associa- Pflug N, et al. Efficacy of antineoplastic treatment is associated with
tion with lymphomas treated with chemotherapy, radiation the use of antibiotics that modulate intestinal microbiota. Onco-
therapy, or both, and is characterized by hyperphosphate- immunology. 2016;5(6):e1150399.
mia, with or without azotemia, hyperkalemia, hypocalcemia, Pierro J, et al. Febrile neutropenia in cats treated with chemother-
metabolic acidosis, and hyperuricemia. It is rare in cats. apy. Vet Comp Oncol. 2016;15:550.
Clinical signs include depression, vomiting, and diarrhea, Shaffer K, Bach J, Chun R. Prospective study evaluating the inci-
dence of bacteraemia and bacteruria in afebrile and febrile
and occur within hours of the start of chemotherapy. neutropaenic dogs undergoing chemotherapy. Vet Med Surg.
At one author’s clinic, 10 cases of canine ATLS were 2016;14:281.
documented in dogs with lymphoma during a period in Skorupski KA, et al. Prospective randomized clinical trial assessing
which approximately 2000 dogs with lymphoma were treated the efficacy of denamarin for prevention of CCNU-induced
with chemotherapy. In most dogs, the pretreatment serum hepatopathy in tumor-bearing dogs. J Vet Intern Med. 2011;25:838.