canine lymphoma

Arises from waht

Lymphoreticular cells (T or B)

Not just lymphoid tissue

Causes

Genetics

Inf - retrovirus, helicobacter

Toxins

Immunology

Common ages + breeds (can affect any)

Middle aged - old

Boxer, bullmastiff, English bulldog, dogue de Bordeaux

Sex with dec risk

FE

Anatomical classifications

Multicentric

Crmediastinal

GI

Cutaneous

Extra nodal

Anatomical classifications - most common type (80%)

Multicentric

Multicentric lymphoma - gross

Generalised peripheral lymphadenopathy

Multicentric lymphoma - CS

Enlarged LN

Rapid deterioration

WL, AL, leth, pyrexia, D, V, cough, ocular

Regional oedema

Cr mediastinal - CS

Dyspnoea, tachypnoea

Hypercalcaemia (PUPD, V, D, m tremor, anorexia, WL)

Pre caval syndrome (ven neck oedema)

Altered CV ausc location (apex)

Alimentary CS

V, D, WL, anorexia, panhypoproteinaemia, malabsorption

Lymphadenopathy

Cutaneous types

Epitheliotrophic - T cell, solitary

Non epitheliotrophic - B cell, generalised

Cutaneous Gross (poorly responsive to chemo)

Raised erythematous plaques/ nodules

Variable pruritus

Extra nodal types

Hepatosplenic - aggressive, no peripheral lymphadenopathy

CNS - neuro deficits, ocular

Renal

Bladder

Heart

Muscle

Common paraneoplastic syndromes with lymphoma

Hypercalcaemia

IMHA, IM thrombocytopenia, Pemphigus foliaceus

B cell monoclonal gammopathies

Neuropathies

Cachexia

Lymphoma types with hypercalcaemia

Mediastinal, GI, multicentric

Dx methods

Cytology

Histopath

Flow cytometry from FNA living cells

IHC

PCR ag receptor rearrangement

Serum biomarkers

Dx - how to determine prognosis with histo

Grade

Immunophenotype (B cell= better, T cell= terrible, null)

Staging (1-5)

1= 1 LN

2 = >1 LN

3 = general LN involvement

4= hep / splenic involvement

5= blood/ BM/ other organ involvement

How to use haematology to assess stage + dx

Thrombocytopenia

Neutrophilia

Lymphocytosis

Abnormal smear cells

How to use biochem to assess stage + dx

Hypercalcaemia

Organ dysfunction

Staging methods

Haem, biochem

FNA, biopsy

Rx, US

BM biopsy

Tx - what happens if no tx done

4-6w survival if asymptomatic

Euth

Tx - What happens if use only prednisolone

1-2mon survival

Chemo resistance

Tx - What happens if multidrug chemo used

Varied survival

Fewer side effects than humans as dec doses + longer intervals

Rarely curative

High dose COP - drugs, features, side effects

Prednisolone, vincristine, cyclophosphamide

Safe to administer

Haem + urine before (sterile H cystitis, immunosupp)

6-9mon survival, 60-80% respond

Discontinuous CHOP/CEOP - drugs, features

Prednisolone, vincristine, cyclophosphamide, doxorubin/epirubicin

10-12mon survival, 90-95% respond

Doxorubin dosage for <10kg (usually mg/m²)

1mg/kg

Chemo side effects

GI = V, D, nausea

Myelosupp = Neutropenia, thrombocytopenia, anaemia

Sterile H cystitis

Cardiotoxicity

Hepatotoxicity

Chemo side effects - drug causing cardiotox (ECG monitoring)

Doxorubicin, epirubicin

Chemo side effects - drug causing hepatotox (monitor ALT)

Lomustine

Chemo side effects - drug causing sterile H cystitis + prevention

Cyclophosphamide

Furosemide

When can sx be done with chemo

Hodgkin’s lymphoma

Extranodal

Stage 1

When can radiation be done with chemo

Stage 1

Palliative

CNS mass

Which drugs do penetrate BBB + can be used for CNS lymphoma

Cytarabine

Lomustine

Steroids

L-asaparaginase

Drugs for epitheliotrophic lymphoma

COP

Lomustine + pred

Retinoids

How to assess response to tx

Palp before + after

CS monitoring

Imaging

Blood

Purpsoe of achieving complete response

Inc time to relapse

Inc survival time

High chance of remission with same protocol

No resistant pop left

Rescue protocols in relapse

DMAC = Dexamethasone, melphalan, actinomycin-D, citarabine

LPP = Lomustine, procarbazine, prednisolone

Doxorubicin/ epirubicin

How often to do follow ups

Monthly <6mon → every 2-3mon

When to restage

No sentinel LN

Not improving

End of induction / discontinuous protocol

Average time to relapse

4mon