Comparison of two melphalan protocols and evaluation of outcome and prognostic factors in multiple myeloma in dogs

Abstract

BackgroundMultiple myeloma (MM) in dogs typically is treated with melphalan. A daily melphalan dosing schedule reportedly is well tolerated and associated with favorable outcome. Although anecdotally a pulse dose regimen has resulted in successful responses, little long‐term outcome and safety data is available regarding this dosing regimen for dogs with MM.Hypothesis/objectives(1) To compare outcome and adverse event profiles between pulse dose and daily dose melphalan schedules and (2) to report prognostic factors in dogs with MM treated with melphalan. We hypothesized that both protocols would have similar outcomes and tolerability.AnimalsThirty‐eight client‐owned dogs diagnosed with MM receiving pulse dose (n = 17) or daily dose (n = 21) melphalan.MethodsRetrospective cohort study assessing outcome and adverse events in dogs receiving either protocol. Risk factors were evaluated for their prognostic relevance.ResultsBoth regimens were well tolerated and similarly effective, with an overall median survival time of 930 days. Renal disease and neutrophil‐to‐lymphocyte ratio (NLR) were negative prognostic factors, whereas hypercalcemia and osteolytic lesions were not prognostic factors in this study population.Conclusions and Clinical ImportancePositive results support the use of either dosing regimen for the treatment of dogs with MM, and renal disease and NLR were negative prognostic factors. Prospective, controlled, and randomized studies are warranted to confirm these findings.

Validation and method comparison of the use of densitometry to quantify monoclonal proteins in canine sera

“…Quantification of immunoglobulins in the dog has largely been restricted to the use of the radial immunodiffusion (RID), ELISA, and automated immunoturbidometric methods; based on current literature, RID appears to be the most commonly used method in veterinary medicine for quantifying the total amount of immunoglobulin . Anecdotally, we observed that the IgA RID kit significantly overestimated immunoglobulin concentrations and had poor diagnostic utility, similar to what has been documented in human medicine .…”

“…A panel of IgG, IgA, and IgM RID tests have been used to determine immunotypes . However, due to the performance characteristics of the RID tests, this practice proved to be unreliable in these samples.…”

Clinicopathological findings in 41 dogs (2008‐2018) naturally infected withEhrlichia ewingii

“…Increased NLR is an indicator of systemic inflammation and is associated with increased circulating cytokines . Neutrophil‐to‐lymphocyte ratio has been used as a prognostic factor in both humans and dogs with malignancies . Evaluating NLR can compensate for fluctuations between individual neutrophil and lymphocyte counts.…”

Plasma cell leukemia with plasmablastic morphology in a dog

“…6,17 In human medicine, plasma cell leukemia is the most aggressive presentation of the plasma cell neoplasms and is characterized by circulating plasma cells > 2 × 10 9 /L or 20% of the 19 Primary plasma cell leukemia is a malignant proliferation of plasma cells first diagnosed in the leukemic phase; secondary plasma cell leukemia corresponds to the leukemic transformation of primary underlying multiple myeloma. 9,19 In our case, using human and canine criteria for the differential diagnosis, many features were more consistent with primary plasma cell leukemia than leukemic multiple myeloma. The high tumor burden and >20% circulating neoplastic cells at the time of the dog's initial presentation is more consistent with primary plasma cell leukemia than with leukemic multiple myeloma.…”