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604 Lymphoma, Gastrointestinal

COP Protocol (Dog)
VetBooks.ir Treatment and Week Week Week Week Week Week Week Week Week Week Weeks 13, †
4
5
6
3
Monitoring
1*
2
8
10
9
7
16, 19, etc.
•
‡
•
CBC
•
•
•
•
•
Cyclophosphamide § • • • • •
Predniso(lo)ne • • • • • • • • • • •
Vincristine ¶ • • • • • • •
*Day of first treatment.
† Continue 3-week cycle through week 52, then continue at 4-week cycle for an additional 6 months.
‡ Complete blood count (CBC) once weekly for first 3-week treatment cycle, then every 3 weeks thereafter to screen for cytopenias, which could postpone or reduce treatment(s):
2
Cyclophosphamide 300 mg/m PO q 3 weeks (administer furosemide 2 mg/kg single dose PO, immediately before to reduce risk of hemorrhagic cystitis; if cystitis develops, cyclophosphamide is terminated
2
permanently and replaced with chlorambucil) or 300 mg/m PO divided over 4 consecutive days q 3 weeks
2
Vincristine 0.75 mg/m IV once weekly × 4 weeks, then q 3 weeks thereafter
Prednisolone 1 mg/kg PO q 24h for 3 weeks, then every other day
§ The cyclophosphamide dosage in this protocol may be too high for some dogs, and it may be preferable to start at a dosage of 200-250 mg/m , with subsequent consideration of escalation to 300 mg/
2
2
m if no toxicoses are noted.
2
¶ The vincristine dosage in this protocol may be too high for some dogs and result in toxicoses; a dosage of 0.5-0.7 mg/m may be preferable as a starting point.
Data from Cotter SM: Treatment of lymphoma and leukemia with cyclophosphamide, vincristine, and prednisone: I. Treatment of dogs. J Am Anim Hosp Assoc 19:159-165, 1983.
CHOP Protocol (Dog)
Treatment and
Monitoring Week 1* Week 2 Week 3 Week 4 Week 5 Week 6 † Week 7 † Week 8 † Week 9 † Week 10 †
CBC ‡ • • • • • • • • • •
L-Asparaginase •
Cyclophosphamide § • •
Doxorubicin • •
Prednisone • • •
Vincristine • • • •
*Day of first treatment.
† Continue/repeat 5-week treatment course (vincristine, cyclophosphamide, vincristine, doxorubicin, off) for two additional cycles to complete 20-week treatment protocol.
‡ Complete blood count (CBC) to screen for cytopenias, which could delay, reduce, or cancel the week’s treatment(s):
2
L-Asparaginase 10,000 IU/m SQ (± pre-treatment with diphenhydramine 2 mg/kg IM 15-30 minutes before L-asparaginase dosing, at clinician’s preference); patient monitored for hypersensitivity/anaphylaxis
× 30 minutes, and if noted, L-asparaginase is terminated permanently. NOTE: If L-asparaginase is not available, the protocol can proceed without the inclusion of this drug.
2
Cyclophosphamide 200-250 mg/m PO or IV (administer furosemide 2 mg/kg single dose PO or IV immediately before to reduce risk of hemorrhagic cystitis; if hemorrhagic cystitis develops, cyclophosphamide
is terminated permanently and replaced with chlorambucil)
2
Doxorubicin for dogs > 10 kg, 30 mg/m IV; for dogs ≤ 10 kg, 1 mg/kg IV
2
2
2
Prednisone 30 mg/m PO q 24h for week 1, then 20 mg/m PO q 24h for week 2, then 10 mg/m PO q 24h for week 3, then stop
2
2
Vincristine 0.5-0.6 mg/m IV for week 1, then 0.7 mg/m IV for weeks 3, 6, 8, and thereafter
§ In some citations, CHOP (cyclophosphamide + hydroxydaunorubicin [doxorubicin] + Oncovin [vincristine] + prednisone) is identical to COAP because hydroxydaunorubicin = doxorubicin = Adriamycin. However,
in some, the A in COAP refers to ara-C, i.e., cytosine arabinoside, whereas in others, the A in COPA refers to asparaginase.
Additional lymphoma treatment/rescue protocols can be found at ExpertConsult.com.
Lymphoma, Gastrointestinal Client Education
Sheet
BASIC INFORMATION (GALT) lymphoma, enteropathy-associated feline leukemia virus (FeLV) infection, a
T-cell lymphoma (EATCL), large granular cause of mediastinal and multicentric LSA
Definition lymphocyte lymphoma, mucosa-associated in young cats, has been largely curtailed
Gastrointestinal (GI) lymphomas/ lymphoid tissue (MALT) lymphoma, neoplasm (p. 329).
lymphosarcomas (LSAs) are malignant tumors of globule leukocytes ○ Cats with GI LSA are typically 7-10 years
of lymphoid cell origin that can arise at any Epidemiology old, although the disease can occur in
location in the GI tract, including the stomach, much older and younger cats.
small intestine, colon, and rectum. Lesions may SPECIES, AGE, SEX • No sex predisposition is noted for dogs or
be of B-cell, T-cell, or large granular lymphocyte • GI LSA is the second most common form of cats.
subtypes and may be high or low grade, distinc- lymphoid malignancy in dogs (after multicen-
tions that are important prognostically. tric LSA), accounting for 5%-7% of all LSAs. GENETICS, BREED PREDISPOSITION
○ Dogs with GI LSA are middle-aged to Dog breeds predisposed include boxers,
Synonyms older (mean 7.7 years). Shar-peis, golden retrievers, springer spaniels,
Alimentary lymphoma, alimentary lym- • GI LSA is currently the most prevalent Doberman pinschers, Labrador retrievers, and
phosarcoma, gut-associated lymphoid tissue anatomic form of LSAs in cats now that German shepherds.
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