Tierarztl Prax Ausg K Kleintiere Heimtiere 2021; 49(03): 185-194
DOI: 10.1055/a-1481-7066
Original Article

Maintenance treatment in relapsed canine lymphoma after a short L-CHOP protocol

Erhaltungstherapie für das rezidivierte Lymphom des Hundes nach einem kurzen L-CHOP-Protokoll
Karin Troedson
Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, LMU Munich, Germany
,
Nataliia Ignatenko
,
Csilla Fejos
,
Yury Zablotski
,
Johannes Hirschberger
› Institutsangaben

Abstract

Objective A number of different rescue protocols for relapsed canine multicentric large-cell lymphoma have been described. The aim of this pilot study was to evaluate the efficacy of a maintenance treatment in dogs that experienced a second complete remission after a short L-CHOP-rescue protocol.

Material and methods Included in the study were dogs experiencing the first lymphoma relapse during a treatment-free period which were treated with a short L-CHOP protocol, achieved a complete remission and were afterwards treated with a continuous maintenance phase (MP) protocol. The L-CHOP protocol consisted of weekly treatments, with at least 3 additional treatments following complete remission. Thereafter the MP protocol with 2-week treatment intervals was conducted. It consisted of alternating oral home administration of different alkylating agents and one intravenously administered cytotoxic agent of a different mechanism of action. The dogs were presented either every 4 or 6 weeks for intravenous treatment and at this time a complete blood count was performed. The durations of the first remission, disease-free interval and overall survival time were evaluated.

Results A total of 20 dogs were included in the study. A median of 7 weekly applications were given before the treatment was switched to the MP protocol. During MP, 14 dogs were treated intravenously every 6 weeks and 6 dogs every 4 weeks. Haematological adverse events were mainly mild. During the L-CHOP-protocol, one septic event occurred, and 2 dogs were hospitalized due to gastrointestinal adverse events. No patient required hospitalization during the MP. Fifteen dogs completed at least one cycle in the MP and a median of 8.5 chemotherapeutic treatments were administered. The median disease-free interval was 264 days and the median overall survival time was 737 days.

Conclusion and clinical relevance The protocol was generally well tolerated. Since 5 patients showed disease progression during the first cycle of the MP, dogs should ideally be evaluated for minimal residual disease before being switched to the MP. The case number in the presented study was low and the treatment relatively heterogeneous. Therefore, more dogs have to be treated with the proposed protocol before general recommendations can be made.

Zusammenfassung

Gegenstand und Ziel Für das rezidivierte kanine multizentrische Lymphom sind viele verschiedene Therapieprotokolle beschrieben. Ziel dieser Pilotstudie war, die Effektivität einer Erhaltungstherapie bei Hunden mit einer zweiten kompletten Remission nach einem kurzen L-CHOP-Protokoll zu evaluieren.

Material und Methoden Eingeschlossen wurden Hunde, die zum Zeitpunkt des ersten Rezidivs nach einer therapiefreien Zeit mit einem kurzen L-CHOP-Protokoll und nach Erreichen einer kompletten Remission mit einem Erhaltungsprotokoll behandelt wurden. Das L-CHOP-Protokoll umfasste wöchentliche Behandlungen mit mindestens 3 Gaben über die komplette Remission hinaus, danach erfolgte die Umstellung auf das Erhaltungsprotokoll mit Therapieintervallen von 2 Wochen. Dieses beinhaltete verschiedene vom Tierbesitzer oral verabreichte Alkylanzien sowie ein intravenös appliziertes Chemotherapeutikum mit einem anderen Wirkmechanismus. Zum Zeitpunkt der alle 4 oder 6 Wochen vorgenommenen intravenösen Behandlung wurde ein Blutbild erstellt. Evaluiert wurden die erste Remissionsdauer, das krankheitsfreie Intervall und die Gesamtüberlebenszeit.

Ergebnisse Bei den 20 in die Studie eingeschlossenen Hunden erfolgten median 7 wöchentliche Behandlungen mit dem L-CHOP-Protokoll, bevor das Protokoll auf die Erhaltungsphase umgestellt wurde. In dieser erhielten 14 Hunde die intravenöse Medikation alle 6 Wochen und 6 Hunde alle 4 Wochen. Hämatologische Nebenwirkungen waren grundsätzlich mild. Ein Hund entwickelte während des L-CHOP-Protokolls eine Sepsis und 2 Tiere mussten wegen gastrointestinaler Nebenwirkungen stationär aufgenommen werden. In der Erhaltungsphase war keine stationäre Aufnahme erforderlich. Bei 15 Hunden fand in der Erhaltungsphase mindestens ein Zyklus statt und median wurden 8,5 Behandlungen durchgeführt. Das mediane krankheitsfreie Intervall betrug 264 Tage, die mediane Gesamtüberlebenszeit 737 Tagen. Bei 6 Hunden gab es keine Verlaufskontrolle.

Schlussfolgerung und klinische Relevanz Das Therapie nach dem Erhaltungsprotokoll wurde im Allgemeinen gut vertragen. Da 5 Hunde im ersten Zyklus eine Progression der Erkrankung zeigten, sollte vor der Umstellung auf das Protokoll der Erhaltungsphase idealerweise eine Untersuchung auf eine nur mikroskopisch nachweisbare Erkrankung stattfinden. Aufgrund der geringen Anzahl an Hunden, die eine relativ heterogene Therapie erhielten, muss das vorgeschlagene Protokoll bei einer größeren Anzahl Hunden Anwendung finden, bevor allgemeine Empfehlungen ausgesprochen werden können.

Supplementary material



Publikationsverlauf

Eingereicht: 17. Mai 2020

Angenommen: 05. Januar 2021

Artikel online veröffentlicht:
22. Juni 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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