Page 412 - Problem-Based Feline Medicine

404 PART 7 SICK CAT WITH SPECIFIC SIGNS

Treatment where the majority of cats were FeLV-negative,
rate of remission was 86% and 1-year survival
Multicentric lymphoma should be treated with
was 57%.
chemotherapy as described in Chapter 31.
● For solitary or regional nodal lymphoma: rate
Some cats with solitary nodal lymphomas have been of complete remission is > 80%, 1-year survival is
cured by surgical excision alone. 35%, and 2 and 3 year survival is 20–30%.
● Because of the tendency for lymphoma to be a sys- ● For primary lymphocytic leukemia: rate of com-
temic disease, chemotherapy is usually recom- plete remission is 25%, 1-year survival is 10%, and
mended following excision. 2 and 3 year survival 5%. Cats with acute pancy-
● If work-up fails to identify lymphoma at another topenia have a worse prognosis.
site, then surgery (or radiation therapy) without
It appears that many cats with solitary Hodgkin’s-like
subsequent chemotherapy may be considered, espe-
lymphoma may be cured with surgical excision alone.
cially for Hodgkin’s-like lymphoma.

Prognosis PLAGUE*
Reported response rates to therapy provide general
information, but it is difficult to give a prognosis for an Classical signs
individual cat.
● Acute high fever.
Providing a prognosis is even more difficult for a cat ● Cranial body regional lymphadenopathy.
with multicentric nodal lymphoma.
● In some studies “multicentric” included extra-nodal See main reference page 383 (The Pyrexic Cat).
lymphomas involving multiple sites.
● Some cats with only peripheral lymph node disease
Pathogenesis
and long-term remissions may have had atypical
hyperplasia or Hodgkin’s-like lymphoma. Infection with Yersinia pestis. Cats are uniquely sensi-
Providing a prognosis for leukemic cats may be com- tive among carnivores.
plicated by difficulty in distinguishing nodal leukemic Most cats appear to be infected by ingestion of an
lymphoma and primary leukemia, which carries a infected rodent. The organism spreads rapidly to the
worse prognosis. regional nodes (mandibular and cervical nodes). Cats
The best predictor of response is response itself, i.e. may also be infected by a bite from an infected flea,
the longer a cat is in remission, the more likely it is where the organism spreads rapidly to the local lymph
to remain in remission. node.
● The organism replicates in the local/regional
FeLV and FIV status does not affect initial response to nodes and from there may progress to other nodes,
therapy. It does negatively affect long-term survival, bacteremia and pneumonia.
mostly because of the occurrence of other FeLV- and
FIV-related disorders.
Clinical signs
Cats with a small tumor burden have a better prognosis.
Signs appear within 1–7 days of infection.
With these caveats, using combination chemotherapy
protocols for the treatment of non-Hodgkin’s nodal High fever (> 40˚C), lethargy, inappetence, dehydra-
lymphoma: tion.
● For multicentric nodal lymphoma: rate of com-
Minimal reaction at site of innoculation.
plete remission is 60–80%, 1-year survival is
10%, and 2 and 3 year survival 5%. These figures Bubonic plague is characterized by marked solitary or
are based on older studies where the majority of regional painful mandibular, retropharyngeal and cer-
cats were FeLV positive. In a more recent study vical lymphadenopathy due to severe lymphadenitis.