Treatment of Feline Gastrointestinal Small-Cell Lymphoma With Chlorambucil and Glucocorticoids

Stein, Timothy J.; Pellin, MacKenzie; Steinberg, Howard; Chun, Ruthanne

doi:10.5326/0460413

Cited by 73 publications

(112 citation statements)

References 14 publications

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“…Based on results presented here, dogs with small cell intestinal lymphoma appear to have a favorable outcome when undergoing any type of therapy, with an MST of 628 days. This is not entirely surprising, given that cats treated with a combination of steroids and alkylating agents (most typically chlorambucil) have MST >600 days(12,16–18), which is comparable to the MST in the current study. More specifically, dogs receiving a combination of steroids and an alkylating agent had a prolonged survival compared to dogs receiving no treatment or receiving treatment with steroids alone ( P =0.002).…”

Section: Discussionsupporting

confidence: 78%

“…Due to the more indolent nature of small cell GI lymphoma in cats, aggressive injectable chemotherapy agents are not usually necessary and signs can generally be managed with long-term oral prednisolone and oral chlorambucil. Reported response rates are as high as 100% with MST ranging from 600–900+ days for cats receiving a combination of prednisone and chlorambucil(12,16–18). …”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics and outcome in dogs with small cell T‐cell intestinal lymphoma

Couto

Moore

Zwingenberger

et al. 2018

Vet Comparative Oncology

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Small cell intestinal lymphoma has not been well characterized in dogs. The objective of this study was to describe clinical characteristics and outcome in dogs with small cell intestinal lymphoma. We hypothesized that affected dogs would have prolonged survival compared to high-grade GI lymphoma. Pathology records were searched for dogs with histologically confirmed small cell GI lymphoma. Seventeen dogs with confirmed small cell intestinal lymphoma were identified, and clinical and outcome data were retrospectively collected. Histopathology was reviewed by a board-certified pathologist, and tissue sections were subjected to immunophenotyping and molecular clonality assessment. All dogs had small cell, T-cell, lymphoma confirmed within various regions of small intestine, with 1 dog also having disease in abdominal lymph nodes. All dogs had clinical signs attributable to GI disease; diarrhea (n=13) was most common. Ultrasonographic abnormalities were present in 8 of 13 dogs with abnormal wall layering (n=7) and hyperechoic mucosal striations (n=7) representing the most common findings. In total, 14 dogs received some form of treatment. The median survival time (MST) for all dogs was 279 days and the MST for the 14 dogs that received any treatment was 628 days. Dogs with anemia and weight loss at presentation had significantly shorter survival times and dogs that received a combination of steroids and an alkylating agent had significantly longer survival times. Small cell, T-cell, intestinal lymphoma is a distinct disease process in dogs, and those undergoing treatment may experience prolonged survival.

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Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and outcome in dogs with small cell T‐cell intestinal lymphoma

Couto

Moore

Zwingenberger

et al. 2018

Vet Comparative Oncology

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“…Glucocorticoids are a mainstay of treatment for GI lymphoma and IBD. [25][26][27] However, the long-term use of glucocorticoids in cats is not without risk of iatrogenic complications. 28,29 If a therapeutic modality could be identified to specifically down-regulate bcl-2 expression or interfere with Bcl-2 activity, relatively lower doses or shorter durations of treatment with glucocorticoids may be necessary for therapeutic management of both diseases.…”

Section: Discussionmentioning

confidence: 99%

Expression of the Bcl-2 apoptotic marker in cats diagnosed with inflammatory bowel disease and gastrointestinal lymphoma

Swanson

Smedley

Saavedra

et al. 2012

Journal of Feline Medicine and Surgery

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Immunolabeling for the critical lymphocyte survival factor, Bcl-2, of intestinal biopsies from cats with histologic evidence of inflammatory bowel disease (IBD) or gastrointestinal (GI) lymphoma was evaluated to determine if expression differed significantly between these two disease processes. Immunolabeling for Bcl-2 was performed on small intestinal endoscopic or full thickness biopsy sections from 55 cats. Diagnosis of IBD, T-cell lymphoma or B-cell lymphoma was established previously. The percentage of infiltrating lymphocytes that were positively labeled for Bcl-2 was subjectively determined for each case. Eight cats were diagnosed with IBD and 47 cats with lymphoma. A significantly higher percentage of cells were positively immunolabeled for Bcl-2 in cats with GI lymphoma [median (range); 90 (5–95)%] compared with cats with IBD [60 (15–95)%] (P = 0.029). However, the overall degree of positive immunolabeling in both groups tended to be high. This over-expression of Bcl-2 may prove useful as a therapeutic target for IBD and GI lymphoma in cats.

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“…Because the majority of cats with lymphoma are ill at diagnosis, it seems reasonable to include clinical sign improvement or progression as part of response assessment in these patients. In fact, several studies describing small cell lymphoma base response solely on changes in clinical signs …”

Section: Discussionmentioning

confidence: 99%

Prospective Clinical Trial to Compare Vincristine and Vinblastine in aCOP‐Based Protocol for Lymphoma in Cats

Krick

Cohen

Gregor

et al. 2012

Veterinary Internal Medicne

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Background: Current standard chemotherapy protocols for lymphoma in cats carry risks of gastrointestinal toxicity, which can decrease quality of life and complicate response assessment. Protocols with less gastrointestinal toxicity may improve treatment tolerance.Hypothesis/Objectives: The study purpose was to compare response rate, outcome, and toxicity between cats that received vincristine or vinblastine as part of combination chemotherapy for lymphoma. We hypothesized that vinblastine would have similar efficacy, but less gastrointestinal toxicity, compared with vincristine.Animals: Forty client-owned cats with confirmed diagnosis of lymphoma. Methods: Cats were randomized to 1 of 2 treatment arms and received weekly COP-based chemotherapy for 6 months or until disease progression. Response rate, progression-free survival (PFS), lymphoma-specific survival (LSS), and incidence and severity of gastrointestinal and hematologic toxicity were compared between arms. Arm cross-over occurred if specific gastrointestinal toxicity criteria were noted.Results: Cats in both arms had similar response rates, PFS, and LSS (48 versus 64 days, P = .87; 139 versus 136 days, P = .96). Cats that received vincristine were significantly more likely to switch arms based on gastrointestinal toxicity than cats that received vinblastine (44.4 versus 10.5%, P = .02). Lower baseline weight was significantly negatively associated with PFS and LSS (P = .01, P = .003, respectively). Baseline anemia was significantly negatively associated with LSS (P = .04).Conclusions and Clinical Importance: Results suggest that vinblastine is a reasonable alternative to vincristine in the treatment of some cats with lymphoma. Baseline body weight remains a significant prognostic factor for cats with lymphoma.

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Treatment of Feline Gastrointestinal Small-Cell Lymphoma With Chlorambucil and Glucocorticoids

Cited by 73 publications

References 14 publications

Clinical characteristics and outcome in dogs with small cell T‐cell intestinal lymphoma

Clinical characteristics and outcome in dogs with small cell T‐cell intestinal lymphoma

Expression of the Bcl-2 apoptotic marker in cats diagnosed with inflammatory bowel disease and gastrointestinal lymphoma

Prospective Clinical Trial to Compare Vincristine and Vinblastine in aCOP‐Based Protocol for Lymphoma in Cats

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