Page 1330 - Small Animal Internal Medicine, 6th Edition

1302 PART XII Oncology

transplantation have been used to some degree in dogs with the latter is one of several University of Wisconsin (UW)
lymphoma, and radiotherapy can also be a useful technique protocols. CHOP-based protocols are similar to those used
VetBooks.ir for treating cats with nasal or solitary epidural lymphoma in people with high-grade lymphomas.
(see Suggested Readings). General guidelines for the man-
COP-Based Protocols
agement of patients with lymphoma are presented here,
although each author has a different mainstay protocol. One of the authors (GC) favors COP-based protocols in dogs
There are two main chemotherapeutic approaches in dogs and cats with large-cell lymphoma. The treatment is divided
and cats with lymphoma: induction chemotherapy, followed into several phases, or strategies: induction of remission,
by maintenance (and reinduction) or more aggressive che- intensification, maintenance, and reinduction of remission or
motherapy for a finite period of time, at the end of which no “rescue” (Box 79.1). Immediately after diagnosis, a relatively
maintenance chemotherapy is used. The former is usually “nonaggressive” multiple-agent COP-based chemotherapy
done with a less aggressive COP (cyclophosphamide, vin- protocol is used to induce remission. During this phase,
cristine, and prednisone)–based protocol, whereas the latter which lasts 6 to 8 weeks, patients are evaluated weekly by a
is usually based on CHOP (cyclophosphamide, doxorubicin, veterinarian, at which time they receive an intravenous (IV)
vincristine, and prednisone)–type protocols. An example of injection of an antimitotic agent (vincristine) in addition to

BOX 79.1
Chemotherapy Protocols Used by the Author to Treat Dogs and Cats* With Lymphoma

1. Induction of Remission Week 17: Doxorubicin 30 mg/m (or 1 mg/kg if
2
a. COP protocol <10 kg) IV
2
Cyclophosphamide: 200-300 mg/m BSA, PO, Week 18: No treatment
2
every 3 weeks (dogs or cats) ‡ Week 19: Vincristine 0.5-0.75 mg/m IV
2
2
Vincristine: 0.5 mg/m BSA, IV, once a week Week 21: Cyclophosphamide 200-250 mg/m IV
2
2
Prednisone: 40-50 mg/m BSA, PO, q24h for a Week 23: Vincristine 0.5-0.75 mg/m IV
2
2
week; then 20-25 mg/m BSA, PO, every other Week 25: Doxorubicin 30 mg/m (or 1 mg/kg if
day or dexamethasone 4-5 mg total dose, PO, <10 kg) IV
q1-3 weeks (in cats only)
b. COAP protocol † 2. Intensification
Cyclophosphamide: 200-300 mg/m PO q3 weeks Dogs 2
2
2
Vincristine: 0.5 mg/m IV weekly L-Asparaginase: 10,000-20,000 IU/m SC or IM (one
Cytosine arabinoside: 100 mg/m daily as an IV or two doses)
2
drip or SC for only 2 days in cats and 4 days in or 2
dogs Vincristine: 0.5-0.75 mg/m IV q1-2 weeks
Prednisone: 50 mg/m PO q24h for 1 week; then Cats
2
2
20 mg/m PO q48h or dexamethasone 4-5 mg Doxorubicin: 1 mg/kg IV q3 weeks
total dose, PO, q1-3 weeks (in cats only) or 2
c. UW-25 protocol (This protocol uses no maintenance Mitoxantrone: 4-6 mg/m IV q3 weeks
chemotherapy—for additional information see text.) 3. Maintenance §
2
Week 1: Vincristine 0.5-0.75 mg/m IV a. LMP protocol
Asparaginase 400 IU/kg, IM or SC Chlorambucil: 20 mg/m PO q2 weeks
2
Prednisone 2 mg/kg PO q24h Methotrexate: 2.5 mg/m PO two or three times per
2
Week 2: Cyclophosphamide 200-250 mg/m IV week
2
Prednisone 1.5 mg/kg PO q24h
2
2
Week 3: Vincristine 0.5-0.75 mg/m IV Prednisone: 20 mg/m PO q48h or dexamethasone
Prednisone 1 mg/kg PO q24h 4-5 mg total dose PO q1-3 weeks (in cats only)
Week 4: Doxorubicin 30 mg/m (or 1 mg/kg if b. Lomustine/prednisone protocol
2
2
<10 kg) IV Lomustine: 60-70 mg/m PO q3 weeks in dogs or
Prednisone 0.5 mg/kg PO q24h 10 mg total dose q3 weeks in cats
Week 5: No treatment Prednisone: 2 mg/kg PO q24h, taper when
Week 6: Vincristine 0.5-0.75 mg/m IV remission obtained or dexamethasone 4-5 mg
2
2
Week 7: Cyclophosphamide 200-250 mg/m IV total dose, PO, q1-3 weeks (in cats only)
2
Week 8: Vincristine 0.5-0.75 mg/m IV
2
Week 9: Doxorubicin 30 mg/m (or 1 mg/kg if c. COP protocol
Use as previously discussed every other week for six
<10 kg) IV
Week 10: No treatment treatments, then every third week for six additional
Week 11: Vincristine 0.5-0.75 mg/m IV treatments, then try to maintain the animal on one
2
2
Week 13: Cyclophosphamide 200-250 mg/m IV treatment every fourth week. Maintenance
2
Week 15: Vincristine 0.5-0.75 mg/m IV therapy is continued until the tumor relapses.