Page 1331 - Small Animal Internal Medicine, 6th Edition

CHAPTER 79 Lymphoma 1303

BOX 79.1
VetBooks.ir Chemotherapy Protocols Used by the Author to Treat Dogs and Cats* With Lymphoma—cont’d

4. Rescue
a. ACD protocol (21-day cycle)
Dogs Cats
a. D-MAC protocol (14-day cycle) Doxorubicin: 1 mg/kg IV on day 1
Dexamethasone: 0.5 mg/lb (1 mg/kg) PO or SC on Cyclophosphamide: 200-300 mg/m PO on day 10
2
days 1 and 8 or 11
2
Actinomycin D: 0.75 mg/m as IV push on day 1 Dexamethasone (4-5 mg total dose q1-2 weeks can
Cytosine arabinoside: 200-300 mg/m as IV drip be added to this protocol)
2
over 4 hours or SC on day 1 b. MiCD protocol (21-day cycle)
2
Melphalan: 20 mg/m PO on day 8 ‖ Mitoxantrone: 4-6 mg/m as IV drip over 4-6 hours
2
b. AC protocol (21-day cycle) on day 1
Doxorubicin: 30 mg/m (or 1 mg/kg for dogs Cyclophosphamide: 200-300 mg/m PO on day 10
2
2
<10 kg) IV on day 1 or 11
2
Cyclophosphamide: 100-150 mg/m PO on days Dexamethasone (4-5 mg total dose q1-2 weeks can
15 and 16 be added to this protocol)
c. Rescue CHOP-based protocol (21-day cycle) c. MiCA protocol (21-day cycle)
2
Cyclophosphamide: 200-300 mg/m PO on day 10 Mitoxantrone: 4-6 mg/m in IV drip over 4-6 hours
2
Doxorubicin: 30 mg/m (or 1 mg/kg for dogs on day 1
2
<10 kg) IV on day 1 Cyclophosphamide: 200-300 mg/m PO on day 10
2
2
Vincristine: 0.75 mg/m IV on days 8 and 15 or 11
Prednisone: 20-25 mg/m PO q48h Cytosine arabinoside: 200 mg/m in IV drip over
2
2
d. MOPP protocol (28-day protocol; repeat 4-6 hours (mixed in the same bag with
continuously until relapse) mitoxantrone) on day 1
2
Mechlorethamine: 3 mg/m IV on day 0, 7 Dexamethasone (4-5 mg total dose q1-2 weeks can
2
Vincristine: 0.7 mg/m IV on days 0,7 be added to this protocol)
Procarbazine: 50 mg/m PO q24h for days 0-13
2
2
Prednisone: 30-40 mg/m PO q24h for days 0-13 5. “Low-Budget” Protocols
2
e. Combination L-asparaginase, lomustine, and Prednisone: 50 mg/m PO q24h for 1 week; then 25 mg/
2
prednisone m PO q48h 2
Lomustine: 60-70 mg/m PO q3 weeks Chlorambucil: 20 mg/m PO q2 weeks
2
2
L-asparaginase: 400 u/kg SC or IM q3 weeks Lomustine: 60 mg/m PO q3 weeks in dogs; 10 mg (total
Prednisone: 2 mg/kg PO q24h, taper when dose) q3 weeks in cats
remission obtained Prednisone and chlorambucil: doses as above
f. Dacarbazine: 800-1000 mg/m2 q14-21d Prednisone and lomustine: doses as above
2
g. Lomustine: 60-80 mg/m q21d
h. Rabacfosadine: 0.82-1 mg/kg IV over 30 minutes
q3 weeks
*Unless otherwise specified, protocols can be used in both dogs and cats.
† Use for 6-10 weeks, then use LMP.
‡ The duration of chemotherapy using this protocol is variable.
§ Use until relapse occurs, then go to “rescue.”
2
‖ After four doses, substitute chlorambucil (20 mg/m PO q2 weeks) for melphalan.
BSA, Body surface area; IM, intramuscular; IV, intravenous; PO, by mouth; SC, subcutaneous.
undergoing a routine physical examination (with or without a dosage of 0.5-0.75 mg/m IV q1-2 weeks). This usually
2
a CBC). If at the end of this phase, the patient is considered suffices to reinduce remission and maintain it for several
to be in complete remission (CR; i.e., all neoplastic masses weeks or months. Alternatively, in suspected or confirmed
have completely disappeared), the maintenance phase is ini- T-cell tumors (in dogs), a maintenance protocol consisting of
2
tiated. During this phase, a multiple-agent chemotherapy lomustine (60-70 mg/m orally [PO] q3-6 weeks) and pred-
protocol consisting of three drugs (chlorambucil [Leukeran], nisone can be used, utilizing the same strategy for relapse as
methotrexate, and prednisone [LMP]) administered orally in dogs on LMP.
is used so that the patient requires less intensive monitor- The maintenance or modified maintenance phase contin-
ing (once every 6-8 weeks). The owners are then instructed ues until the tumor relapses (i.e., is out of remission), at
to closely monitor the size of the lymph nodes in their which time the reinduction phase begins. This phase is
pets; when the nodes start enlarging (i.e., relapse), a fourth similar to the induction phase in that intensive treatments
drug is added to the LMP protocol (usually vincristine, at are used. Once remission is obtained, the patient is started