Page 769 - Withrow and MacEwen's Small Animal Clinical Oncology, 6th Edition

CHAPTER 33 Hematopoietic Tumors 747

Serum IgA Total globulins
40000 normal 40–160 mg/dL 8
VetBooks.ir 30000 6

[IgA], mg/dL 20000 Globulin, g/dL 4

range
10000 2 Normal

0 0
A 0 4 8 12 16 20 24 B 0 4 8 12 16 20 24

Hematocrit Platelets

60 500
400
50
PCV (%) 40 Platelets/dL 300 Normal

range
200
30
100

20 0
C 0 4 8 12 16 20 24 D 0 4 8 12 16 20 24

Serum calcium Total white blood cells
15
14
14
12
13 10
12
[Ca] WBC per dL 8
11 6 Normal
range
10 4
9 2
8 0
0 4 8 12 16 20 24 0 4 8 12 16 20 24
E Week F Week
• Fig. 33.29 Clinicopathologic data changes over time (weeks) after initiation of cytotoxic chemotherapy
in three dogs with IgA multiple myeloma. Light blue area, Normal reference range. (A) Serum IgA (mg/dL);
(B) Total globulins (g/dL). (C) Hematocrit (%). (D) Platelets/dL. (E) Serum calcium (mg/dL). (F) Total white
blood cells/dL.

As previously discussed, complete resolution of MM does not be differentiated from myelophthisis due to neoplastic marrow
generally occur and a good response is defined as a reduction in recurrence.
measured M-component (i.e., immunoglobulin or Bence Jones
proteins) of at least 50% of pretreatment values. 764 Reduction in Therapy Directed at Complications of Multiple Myeloma
serum immunoglobulin levels may lag behind reductions in Bence The long-term control of complications, including hypercalcemia,
Jones proteinuria because the half-lives are 15 to 20 days and 8 to HVS, bleeding diathesis, renal disease, immunosuppression with
12 hours, respectively. 841 For routine follow-up, quantification of infection, ophthalmic complications, and pathologic skeletal frac-
the increased serum globulin, immunoglobulin, or urine Bence tures, depend on controlling the primary tumor mass. However,
Jones protein is performed monthly until a good response is noted therapy directed more specifically at these complications may be
and then every 2 to 3 months thereafter. Repeat bone marrow aspi- indicated in the short term.
ration or imaging (in the case of visceral disease) for evaluation of If hypercalcemia is marked and significant clinical signs exist,
plasma cell infiltration may be occasionally necessary. Bone mar- standard therapies, including fluid diuresis, with or without phar-
row reevaluation is particularly prudent when cytopenias develop macologic agents (e.g., zoledronate, calcitonin), may be indicated
during chemotherapy, and drug-induced myelosuppression must (see Chapter 5). Moderate hypercalcemia will typically begin to