Assessment of temporal association of relapse of canine multicentric lymphoma with components of the CHOP protocol: Is cyclophosphamide the weakest link?

Wang, Shang-Lin; Lee, J.; Liao, Albert

doi:10.1016/j.tvjl.2016.04.013

Cited by 8 publications

(10 citation statements)

References 6 publications

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“…Cyclophosphamide was replaced with lomustine, and thus an alkylating agent was still used in the LEOP protocol. Whilst cyclophosphamide is a core drug in CHOP protocols, it does appear to be the least efficacious as a single agent . Some recent studies have also challenged the idea that CHOP should be the standard protocol for dogs with high grade lymphoma, including HGTCL …”

Section: Discussionmentioning

confidence: 99%

“…Lomustine, a nitrosourea alkylator, is commonly used in canine lymphoma and can be effective as a single agent, even in relapsed disease . The authors of the present study have found that lomustine induces good response in patients with HGTCL as a single agent, and it has been suggested that cyclophosphamide is the least effective agent in a CHOP protocol . An institutional change, replacing cyclophosphamide with lomustine in our standard, multi‐agent chemotherapy protocol, was therefore undertaken.…”

Section: Introductionmentioning

confidence: 93%

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A Retrospective Study of Multi‐agent Chemotherapy including either Cyclophosphamide or Lomustine as Initial Therapy for Canine High‐grade T‐cell Lymphoma (2011‐2017)

Elliott

2019

Aust Veterinary J

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Multi-agent chemotherapy (vincristine, epirubicin and prednisolone) including either cyclophosphamide (CEOP) or lomustine (LEOP) was given as first-line chemotherapy to treatment-naïve canine lymphoma patients with measurable, high grade T-cell lymphoma (HGTCL). All patients responded to either CEOP or LEOP. Toxicity was typical of multi-agent chemotherapy protocols and 25% of dogs receiving lomustine exhibited mild-to-moderate ALT elevation and 29% grade 3 or 4 neutropenia. Median progression-free survival (100 versus 269 days) and overall survival (155 versus 327 days) were significantly higher in patients receiving LEOP compared to CEOP. Overall survival was improved for patients receiving LEOP compared to those receiving CEOP followed by lomustine-based rescue therapy. The results of this retrospective study support further evaluation of lomustine as part of first-line, multi-agent therapy for patients with HGTCL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

A Retrospective Study of Multi‐agent Chemotherapy including either Cyclophosphamide or Lomustine as Initial Therapy for Canine High‐grade T‐cell Lymphoma (2011‐2017)

Elliott

2019

Aust Veterinary J

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“…19 In a recent study investigating the use of 25-week CHOP in dogs, the authors suggested a temporal relationship existed between relapse of lymphoma and cyclophosphamide. 61 Although further investigation is necessary to confirm this observation, efforts could be focused on improving DI of drugs considered most useful for the disease. Results provided here suggest that the severity of prechemotherapy neutropenia is not necessarily associated with an increase in postchemotherapy nonhematologic toxicity.…”

Section: Discussionmentioning

confidence: 96%

“…Indeed, a relative dose reduction in vincristine has been associated with poorer outcome in human patients diagnosed with diffuse large B‐cell lymphoma treated with R‐CHOP . In a recent study investigating the use of 25‐week CHOP in dogs, the authors suggested a temporal relationship existed between relapse of lymphoma and cyclophosphamide . Although further investigation is necessary to confirm this observation, efforts could be focused on improving DI of drugs considered most useful for the disease.…”

Section: Discussionmentioning

confidence: 99%

Impact of Pretreatment Neutrophil Count on Chemotherapy Administration and Toxicity in Dogs with Lymphoma Treated with CHOP Chemotherapy

Fournier

Serra

Handel

et al. 2017

Veterinary Internal Medicne

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BackgroundPrechemotherapy absolute neutrophil count (ANC) cutoffs are arbitrary and vary across institutions and clinicians. Similarly, subjective guidelines are utilized for the administration of prophylactic antibiotics in neutropenic dogs.ObjectivesTo evaluate the impact of various ANC cutoffs on chemotherapy administration in dogs with lymphoma treated with CHOP chemotherapy and to determine whether an association between prechemotherapy ANC and subsequent toxicity exists. The secondary objective was to evaluate a currently used ANC cutoff to indicate prescription of prophylactic antibiotics.AnimalsDogs diagnosed with lymphoma treated with CHOP chemotherapy (n = 64).MethodsSix hundred and fifteen ANCs were stratified into 6 classes. The 3 ANC cutoffs 1.5 × 103/μL, 2.0 × 103/μL, and 2.5 × 103/μL were assessed. The presence of an association between prechemotherapy ANC class and toxicity was determined. Afebrile neutropenic dogs with ANC <1.5 × 103/μL but above the criteria for prophylactic antibiotics were evaluated.ResultsChemotherapy was not administered in 7% of visits with an ANC cutoff of 1.5 × 103/μL; chemotherapy would not have been administered in 10% and 16% of visits with an ANC cutoff of 2.0 × 103/μL or 2.5 × 103/μL, respectively. There was no association among the 3 lower prechemotherapy ANC classes and toxicity. All dogs with ANC 0.75–1.5 × 103/μL recovered spontaneously without medical intervention.Conclusion and Clinical ImportanceThe number of dose delays was minimized with a prechemotherapy ANC cutoff of 1.5 × 103/μL, and the prechemotherapy ANC class 1.5–1.99 × 103/μL was not associated with an increased toxicity. Further investigation of an ANC cutoff near 0.75 × 103/μL in which to prescribe prophylactic antibiotics is indicated.

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“…Dogs with lymphoma showed a lower relapse rate after doxorubicin administration than after vincristine and cyclophosphamide (Wang et al, 2016). Our study compared treatment efficacy between the mL-COP and mL-CHOP protocols using MRD detection with hPARR.…”

Section: Discussionmentioning

confidence: 98%

Monitoring minimal residual disease in canine lymphomas treated with modified L-COP or L-CHOP protocols

Sirivisoot

Teewasutrakul

Techangamsuwan

et al. 2018

Acta Veterinaria Hungarica

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Heteroduplex polymerase chain reaction for antigen receptor rearrangements (hPARR) was developed to monitor minimal residual disease (MRD) in canine B- and T-cell lymphomas treated with the modified L-COP or L-CHOP protocol. Thirty-five dogs were recruited in this study and their neoplastic lineages were determined by immunophenotyping with Pax5 and CD3. Peripheral blood leukocytes were collected prior to and during chemotherapy in weeks 4, 9 and 13 to detect MRD by hPARR. Twenty-eight dogs (80%) had B-cell lymphoma while seven dogs (20%) had T-cell lymphoma. A monoclonal band was detected in 11 cases that showed complete or partial remission before tumour relapse and no response to the current treatment without statistical difference in clinical outcomes; however, the treatment response had an association with the MRD result (P < 0.05). Modified L-CHOP prolonged median progression-free survival as compared to modified L-COP (215 days vs. 93 days; P < 0.05). Substage b had shorter progression-free survival than substage a (90 days vs. 215 days; P < 0.05). Clinical stage III affected median overall survival time when compared to clinical stages IV and V (432, 173 and 118 days, respectively; P < 0.05). hPARR could be used for screening refractory lymphoma together with lymph node measurement in routine clinical cases.

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Assessment of temporal association of relapse of canine multicentric lymphoma with components of the CHOP protocol: Is cyclophosphamide the weakest link?

Cited by 8 publications

References 6 publications

A Retrospective Study of Multi‐agent Chemotherapy including either Cyclophosphamide or Lomustine as Initial Therapy for Canine High‐grade T‐cell Lymphoma (2011‐2017)

A Retrospective Study of Multi‐agent Chemotherapy including either Cyclophosphamide or Lomustine as Initial Therapy for Canine High‐grade T‐cell Lymphoma (2011‐2017)

Impact of Pretreatment Neutrophil Count on Chemotherapy Administration and Toxicity in Dogs with Lymphoma Treated with CHOP Chemotherapy

Monitoring minimal residual disease in canine lymphomas treated with modified L-COP or L-CHOP protocols

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