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Macadamia Nut Toxicosis 613

handling requirements and potentially life- • Mitoxantrone (single agent): 47% CR rate • Many protocols exist, and the order in
for median of 84 days
threatening adverse effects exist with many of • Vinblastine (single agent): 8% CR rate for which they are applied generates highly
VetBooks.ir Dogs: • Combination carboplatin and cytarabine: 25%-50% of dogs respond to rescue therapy Diseases and Disorders
variable prognostic information. In general,
the following antineoplastic drugs.
median survival time of 46 days
• Alkylating agents are not affected by the
for a median of 2-6 months; longer and
MDR phenotype and rarely show cross-
shorter times are possible.
resistance to each other, making drugs in overall response rate of 18%, with median • There is insufficient information in cats to
survival time of 109 days
this class a good choice for rescue therapy: Cats: generalize about the prognosis for rescue
○ Lomustine (CCNU) as single agent: 27% • Extremely limited information (small-scale, treatment.
response rate for median of 86 days heterogeneous studies)
○ LAP protocol (lomustine, L-asparaginase, • Doxorubicin ± lomustine: ≈10% CR rate, PEARLS & CONSIDERATIONS
and prednisone): 77% response rate (65% ≈10 PR rate, median progression-free interval
CR) for median of 70 days of 39 days Comments
○ Lomustine and dacarbazine (DTIC): 23% • Radiation therapy (relapsed GI lymphoma): • Most cats and dogs with lymphoma experi-
CR rate for median of 83 days, 12% PR 90% response rate, 214 days median survival ence a relapse regardless of initial therapy.
rate for median of 25 days after radiation therapy, 355 days median • Relapse occurs most often because neoplastic
○ MOPP protocol (mechlorethamine, overall survival time cells are resistant to treatment but may occur
vincristine [Oncovin], procarbazine, and due to controllable (i.e., avoidable) factors.
prednisone): 31% CR for median of 63 Possible Complications • After resistance to first-line chemotherapy
days and 34% PR for median of 46 days Doxorubicin cardiotoxicosis: a complete cardiac occurs, many different rescue protocols are
○ LOPP protocol (lomustine, vincristine, pro- evaluation is recommended before the seventh available. Considerations for selection of
carbazine, and prednisolone): 50%-61% (and before every treatment thereafter) cumula- rescue protocols include a combination of
overall response rate for median remission tive lifetime dose in dogs, sooner if suspicion of efficacy, side effects, cost, time commitment,
duration of 93-140 days cardiac disease (infiltration, cardiac arrhythmias) and individual patient needs, including
○ BOPP protocol (carmustine, vincristine, exists. Dexrazoxane can be coadministered with patient performance status.
procarbazine, and prednisolone): 52% doxorubicin for cardioprotection.
overall response rate (median CR duration, Technician Tips
112 days; PR duration, 85 days) Possible Complications Technicians should be familiar with the che-
○ MOMP protocol (mechlorethamine, • Extensive list of potential adverse effects motherapy drugs in rescue protocols, including
vincristine, melphalan, and prednisone): associated with chemotherapy agents (p. 152) proper handling, administration, disposal,
12% CR rate for median of 81 days and • Complications related to progression of anticipated reactions, and side effects.
39% PR rate for median of 49 days lymphoma in any affected organ (e.g., kidney
○ MPP protocol (mechlorethamine, mel- failure due to renal lymphoma, seizure due to Client Education
phalan, and prednisone): 17% CR rate central nervous system lymphoma, respira- After relapse, treatment can often result in a
for median of 238 days and 17% PR rate tory distress due to pulmonary lymphoma) second response with an excellent quality of
for median of 56 days life, but cure is not possible, and the disease
○ DMAC protocol (dexamethasone, mel- PROGNOSIS & OUTCOME will eventually relapse yet again.
phalan, actinomycin D, and cytosine
arabinoside): 44% CR rate for median • Variety of protocols and heterogeneity of SUGGESTED READING
of 112 days and 28% PR rate for median patient responses make prognoses highly Gustafson DL, et al: Cancer chemotherapy. In
of 44 days varied. Withrow SJ, et al, editors Small animal clinical
○ ADIC protocol (doxorubicin and dacar- • For dogs receiving rescue treatment with a oncology, ed 5, St. Louis, 2013, Saunders, pp
bazine) when resistant to single-agent CHOP protocol after having successfully 157-179.
doxorubicin: 33% CR rate for median completed an initial 6-month CHOP AUTHOR: Joanne L. Intile, DVM, MS, DACVIM
< 42 days and PR in 20% protocol, second remissions occur in 78% EDITOR: Kenneth M. Rassnick, DVM, DACVIM
• Actinomycin D (single agent): 41% CR of cases for a median duration of 5 months.
rate for median disease-free interval of 129 These second remissions are longer in dogs
days with first remissions that were > 9 months.

Macadamia Nut Toxicosis Client Education
Sheet

Epidemiology
BASIC INFORMATION tetraphylla. In the United States, macadamia
SPECIES, AGE, SEX nuts are cultivated mainly in Hawaii but are
Definition Currently, macadamia nut toxicosis has been also found in Florida and California. Products
• Acute and transient syndrome in dogs reported in dogs only. There does not appear containing the nuts are widely available year-
resulting from ingestion of macadamia to be a breed, age, or sex predisposition. round. Popularity increases during holiday
nuts seasons and risk of exposure for dogs is higher
• Common signs include lethargy, gastro- GEOGRAPHY AND SEASONALITY during these times.
intestinal (GI) upset, weakness, ataxia, Two tree species used for cultivating the edible
trembling, and mild hyperthermia. nuts are Macadamia integrifolia and Macadamia

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