Association of globulin concentrations with prognosis in horses with lymphoma

Abstract

IntroductionLymphoma is the most common hemopoietic neoplasia in horses. Common clinicopathologic abnormalities in equine lymphoma include hyperglobulinemia, hypoalbuminemia, hyperfibrinogenemia, anemia, thrombocytopenia and lymphocytosis. Hypoglobulinemia has been reported in other species with lymphoma, however it has not been well-described in horses. The objectives of this study were to examine the prevalence of hypoglobulinemia in equine lymphoma, and to identify prognosis and clinicopathological abnormalities associated with serum globulin concentrations.MethodsNinety-six horses with lymphoma were investigated in this retrospective study. Patients were allocated into groups based on serum globulin concentration. Survival analysis was performed to determine risk factors associated with globulin concentration and outcome.ResultsNineteen horses were hypoglobulinemic (≤2.1 g/dL), 63/98 were normoglobulinemic (2.2–4.3 g/dL), and 16/98 were hyperglobulinemic (≥4.4 g/dL). Hyperglobulinemia was associated with a higher anion gap (P = 0.0005), lower bicarbonate (P = 0.006), sodium (P = 0.03) and chloride concentrations (P = 0.002), and higher total protein than hypoglobulinemic horses (P < 0.0001). For location, 37% of horses with mucocutaneous lymphoma were hypoglobulinemic, compared to none in the hyperglobulinemic group (P = 0.02). Survival times were significantly different between low, normal and high globulin groups (P = 0.0002, median [range] survival times: 333 [1–3792], 43 [1–4,001] and 4 [1–129] days, respectively). Significant risk factors for shortened time to death were hyperglobulinemia (HR 2.4, P = 0.02), T cell lymphoma (HR 3.5, P < 0.0001), and multicentric (HR 3.1, P = 0.0008) and mediastinal (HR 6.4, P = 0.006) forms of lymphoma. Lack of chemotherapy was associated with shortened survival time (HR 4.5, P < 0.0001). B cell lymphomas (P < 0.0001) and mucocutaneous lymphoma location (P < 0.0001) were associated with longer survival times.DiscussionSerum globulin concentrations are associated with location of lymphoma, clinicopathologic abnormalities, and survival times in equine lymphoma.

A case of equine multicentric lymphoma: Clinical, microscopical and molecular findings

“…In this animal, the most evident biochemical alterations during the course of the disease were hyperglobulinemia and hypoalbuminemia, concordant findings in animals with lymphoma. Hyperglobulinemia may reflect a systemic inflammatory response to tumour necrosis ( Ness, 2016 ), a paraneoplastic process or atypical antibodies generated by neoplastic lymphocytes ( Wensley et al ., 2023 ). It may also result in down-regulation of albumin synthesis, which may also be diminished by inadequate intake and absorption of nutrients ( Wensley et al ., 2023 ).…”

“…Hyperglobulinemia may reflect a systemic inflammatory response to tumour necrosis ( Ness, 2016 ), a paraneoplastic process or atypical antibodies generated by neoplastic lymphocytes ( Wensley et al ., 2023 ). It may also result in down-regulation of albumin synthesis, which may also be diminished by inadequate intake and absorption of nutrients ( Wensley et al ., 2023 ). The proteinogram revealed a monoclonal gammopathy due to the overproduction of immunoglobulins, suggestive of lymphoid neoplasia.…”

“…The proteinogram revealed a monoclonal gammopathy due to the overproduction of immunoglobulins, suggestive of lymphoid neoplasia. A recent study on equine lymphoma performed by Wensley et al . (2023) associated high concentrations of globulin with decreased survival time, suggesting that hyperglobulinemia acts as a negative prognostic factor in this disease.…”

“…Although not yet fully clarified in horses, T-cell lymphoma is generally more aggressive and has a poorer prognosis when compared to B-cell lymphoma ( Taintor and Schleis, 2011 ). Furthermore, the multicentric and mediastinal forms were also associated with decreased survival time compared to other locations ( Wensley et al ., 2023 ). Regardless of lymphoma subtype, the prognosis is poor, and the survival time is variable and depends on the extension of the disease and organs involved ( Ness, 2016 ).…”

Primäre Immunschwächeerkrankungen des Pferdes mit Schwerpunkt auf der Common Variable Immunodeficiency (CVID) beim adulten Pferd

“…In diesen Fällen wären folglich auch klinische oder labordiagnostische Veränderungen zu erwarten, die mit der Autoimmun- oder lymphoproliferativen Erkrankung einhergehen. So wird in einer Fallserie von Lymphompatienten 17 ein 13-jähriger Wallach mit mukokutanem T-Zell- und Histiozyten-reichem B-Zell-Lymphom erwähnt, der gleichzeitig mit einer CVID diagnostiziert wurde: Multiple und wiederkehrende Infektionen (Salmonellen-Enteritis, Pyelonephritis, Pneumonie, intramuskulärer Abszess und fungale Keratitis) standen in Verbindung mit beeinträchtigter Antikörperproduktion mit sehr niedriger IgM- und IgG-Konzentration 17 . Das gleichzeitige Vorkommen von lymphoproliferativen Erkrankungen oder anderen immunmediierten Erkrankungen ist folglich bei entsprechenden CVID-Patienten mitzuberücksichtigen.…”