Canine Lymphoma (Lymphosarcoma)

Canine Lymphoma can be Treated

Lymphosarcoma is a common cancer of lymphocytes in dogs and can occur in the lymph nodes, spleen, liver, and other organs.

Most lymphomas can be treated and respond very well to a combination of chemotherapy and an immune system enhancer, such as K9 Immunity. Lymphoma has the one of the highest rates of remission of any canine cancer.

Immune Support and Artemisinin/Artemix along with DHA supplementation and an appropriate diet for dogs with cancer, has also assisted in supporting quality of life for dogs where chemotherapy was not considered an option.

The lymph system circulates white blood cells, including lymphocytes- specialized cells involved in immune function that are found throughout the body. In normal healthy dogs, these cells go through a life span of around 30 days, and then die off and are re-absorbed into the body or eliminated through the waste channels. In Lymphoma, the body loses regulation of lymphocyte production and these cells proliferate in large numbers, overwhelming the other blood cells. High white blood cell count and swollen lymph glands are the characteristic signs of this disease, followed by lethargy, loss of appetite and leading eventually to death unless treated.

Immune support compounds such as heteropolysaccharides, which are naturally occurring in our foods and are required in all mammals for triggering normal immune function form K9 Immunity, and help to support the Immune system while a dog is fighting disease. It consists of extracts from six mushrooms, Agaricus blazei, Cordyceps sinensis hybrid, lentinula edodes, Gri.fola frondosa, Ganoderma lucidium, and Coriolus versicolor. Click here to see articles on medicinal mushrooms.

Chemotherapy and sometimes surgery are both effective in removing the bulk of the tumors, but may be seen as only one arm of a multi-pronged approach involving appropriate diet and support to help boost the Immune system. Click here to see articles on nutrition and cancer.

How well any dog will respond to therapy is difficult to generalize. Treatment success depends on many factors, such as the dog's age, his or her diet, their medical history, where the cancer is located and how extensive it is, and what major systems are involved. Generally speaking, the earlier lymphoma is diagnosed the better the outcome will be.

Lymphoma,involves the lymph system including the lymph nodes and sometimes the liver and spleen. Often middle aged to older dogs of either sex are potential victims of this disease.

Lymphoma is classified by stage:

In cases of lymphoma that are not as straightforward as the classical Multicentric lymphoma described below, staging may be more important. Staging used to be done regularly after the initial diagnosis of lymphoma but it has since been found that stage of disease does not impact upon the response to chemotherapy (ie it is not true that a stage II will have a better response than a stage IV). The exception is Stage V, the most advanced stage. Patients with stage V lymphoma tend to have a poor response to chemotherapy.

We recommend K9 Immune Assist to help support your dog while fighting this disease.

K-9 Immunity(tm) was first developed for Seeing Eye dogs being treated for cancer, and is now available for your dog. K-9 Immunity(tm) has been used in over 10,000 dogs with cancer and serious health issues.

K-9 Immunity(tm) contains dietary supplements known as hetero-polysaccharides, including PSK, PSP and Lentinan. This formula also contains nearly 200 other closely related polysaccharide which may trigger other aspects of immune function. These compounds are sometimes referred to as glyconutrients, and are required for correct immune function in all mammals. K-9 Immunity(tm) is an all-natural, non-toxic daily supplement made from 100% USDA Certified Organic materials. It is made in America at Aloha Medicinals FDA registered facility to the highest pharmaceutical standards.

We also recommend using artemisinin/artemix along with Immune support to assist your dog in fighting lymphoma.Much research has been done in the laboratories by researchers such as Prof. Singh and Prof Lai of the Washington University. Some animal testing has already taken place with exciting results.

Since the first exciting discovery for the use of Artemisinin, there have been numerous trials some of which are currently underway including canine trials at the University of OHIO. Very promising results have been reported by doctors and researchers who have worked with it.

Further information about Artemisinin and Artemix can be found here on our website.

We also recommend dogs fighting lymphoma should be taking DHA supplements, and incorporating omega3s , such as found in oily fish, flaxseed oil, etc. to assist them as it has been shown it :

• can inhibit tumor growth and development, and;
• appears to be important in reducing radiation and chemotherapy induced toxicity while increasing the efficacy of these therapies.

Further information about DHA Omegas can be found here on our website.

Dogs with lymphoma should also be adhering as much as possible to a suitable diet for dogs with cancer.

Diet/Nutrition has been shown to play an important part in helping a dog with cancer fight the disease, and maintain energy. See Prof. G. Ogilvie's article on Nutrition and Diet in the Research and Information pages on our website.

In simple terms, carbohydrates have been shown to feed the cancer, which is not desirable, whereas fats, especially omega 3s, and good quality proteins do not, they starve the cancer, and help your dog maintain energy.

Research by Professor G. Ogilvie on Lymphoma Treatment with Chemotherapy

Chemotherapy has become a common treatment for dogs with cancer, offering a 60 to 90 percent remission rate for dogs with lymphoma. However, chemotherapy can result in blood, gastrointestinal or dermatological toxicity. Additional effects can include behavioral changes such as scratching, shivering, vomiting, anorexia, fatigue and reduction in grooming. Owners and veterinarians use behavioral signs such as these to assess the overall well-being of patient The mainstay treatment of lymphoma is combination chemotherapy in which a variety of drugs are given according to a specific plan or protocol. Many chemotherapy protocols exist and they are ever-changing. Commonly, prednisone, a steroid drug will be given alone or in conjunction with other chemotherapy drugs to decrease the inflammation that occurs in the dogs body due to the action of the disease or the effect of the chemotherapy. A word of caution is offered here and that is if you decide not to proceed with chemotherapy and to use prednisone alone and later decide to begin chemotherapy, the chemotherapy will be less effective because of the initial prednisone use.

K9 Health Support have a long professional association with Professor G. K. Ogilvie (DVM Diplomate ACVIM (Specialties of Internal Medicine and Oncology), Professor of Oncology and Internal Medicine, Animal Cancer Center, Medical Oncology Research Laboratory, College of Veterinary Medicine and Biomedical Sciences, Colorado State University. The following information is reproduced here with his kind permission.

Canine Lymphoma - Author: Gregory K. Ogilvie, DVM, DACVIM (Internal Medicine, Oncology)

It is important that the client be given all the options and that the best option be used first. As a general rule, combination chemotherapy is superior to single-agent therapy. Each time an effective drug is added to the COP protocol, the remission duration increases; however, so do the cost and the potential for toxicity. It is also important that clients realize that a second or third remission is possible with appropriate therapy but that these subsequent remissions are more difficult to attain and that their duration is generally half the duration of the previous remission.

The treatment options below are tiered according to risk of toxicity, cost, and efficacy. First-level protocols provide a low risk of toxicity at low cost but have low efficacy; as the level rises, so do efficacy, cost, and risk of toxicity.

First Level: For clients who cannot afford or will not accept a combination chemotherapy protocol due to the risks of toxicity, a protocol using prednisone alone (40 mg/m2 PO daily for 7 days then every other day) or in combination with chlorambucil (6 to 8 mg/m2 PO every other day) may provide palliation with few risks of side effects. A CBC should be collected every 2 to 3 weeks to make sure that myelosuppression is not occurring.

Second Level: The COP protocol is a relatively inexpensive chemotherapy protocol with a low risk of toxicity. Dogs tolerate the treatments, and veterinarians find the protocol very manageable. CBCs should be taken 1 week after each dose of cyclophosphamide to ensure that myelosuppression (if it occurs) is not severe and that doses do not need to be adjusted.

Doxorubicin administered every 3 weeks for five to eight treatments at a dosage of 30 mg/m2 (1 mg/kg for small dogs) is the most effective single chemotherapeutic agent. This treatment regimen results in a relatively high remission rate with relatively few serious life-threatening toxicities (<5%). With the advent of generic doxorubicin, the cost is reasonable for most clients. Because the drug is given every 3 weeks, this treatment approach is less time intensive than most chemotherapeutic protocols. A second remission seems more likely if with doxorubicin is used as first-line therapy and COP is used after relapse than if COP is used first.(1) Overall remission time for the two-protocol treatment approach is similar to that of the COPA protocol.(2)

Third Level: The most effective chemotherapy protocols use a five-drug combination of L-asparaginase, vincristine, cyclophosphamide, doxorubicin, and prednisone. Similar remission rates and survival times have been obtained for the protocols that include these drugs.3-7 Although these protocols require more intense client-veterinarian communication and monitoring for toxicity, the overall level of satisfaction for owners, pets, and veterinarians is high. Most oncologists recommend discontinuous protocols such as VELCAP-S or the Wisconsin protocol; however, some clients will not restart chemotherapy when first remission is over.(8,9)

For dogs with T-cell lymphoma, protocols that rely heavily on alkylating agents, such as Tufts VELCAP-SC, should be used.(10)

Table 47-10. Wisconsin protocol: Vincristine is administered at 0.5 to 0.7 mg/m2 IV. L-asparaginase is given at 400 IU/kg IM. The dose for cyclophosphamide* is 200 mg/m2 IV. Doxorubicin is administered at 30 mg/m2 IV. The dose for prednisone is 2.0 mg/kg PO, week 1; 1.5 mg/kg PO, week 2; 1.0 mg/kg PO, week 3; and 0.5 mg/kg PO, week 4.

From week 25, repeat weeks 11 to 17, but every 3 weeks. After week 49, treatments given every 4 weeks.

Fourth Level: The addition of radiation therapy or, if available, autologous bone marrow support to allow chemotherapy dose intensification represents the best possible treatment option for a dog with lymphoma. The potential for long-term remission and possibly cure is much higher than with other protocols. Dogs with T-cell lymphoma may not benefit to the same extent as those dogs with B-cell lymphoma. Although risks of toxicity are higher, the addition of radiation or chemotherapy dose intensification has not negatively affected the quality of life for treated dogs.

High-dose chemotherapy with hematopoietic stem cell support or bone marrow transplantation (BMT) has become an important component of therapy for lymphoma and other malignancies in humans. Although combination chemotherapy results in a complete remission rate of 75% or greater in dogs, relapses frequently occur after a median of 10 to 12 months. It appears that autologous BMT allows dogs to receive intensified doses of myelosuppressive chemotherapy without increased toxicity and that this intensification improves remission duration and overall survival.

In a reported protocol reported by AS Moore and A Fermberger based on VELCAP-S, dogs in CR at week 8 were treated with filgrastim (G-CSF) followed by bone marrow collection. A high dose of cyclophosphamide was given with mesna followed by prophylactic antibiotics, and bone marrow was administered intravenously. Three dosage levels of cyclophosphamide were used: 300 mg/m2 (3 dogs), 400 mg/m2 (12 dogs), and 500 mg/m2 (13 dogs). Toxicity was acceptable, with only one dog requiring hospitalization after transplant for complications that resolved in 24 hours. Remission duration was not significantly different for dogs receiving 300 mg/m2 or 400 mg/m2. For dogs receiving 500 mg/m2, the median remission was 12.4 months, significantly longer than for dogs receiving 400 mg/m2, with 6 of 13 dogs still in remission between 6 and 33 months after starting chemotherapy and 1-year survival of 57.1%. Using autologous bone marrow to support chemotherapy dose intensification allows dogs to receive 2.5 times the standard dose of cyclophosphamide without any increase in clinical toxicity. This dose intensification results in significant prolongation of remission.

Supportive and Nutritional Treatment for Canine Lymphoma

The induction death rate decreased markedly for the VELCAP-SC protocol compared with previous protocols, despite an increase in the percentage of dogs needing a dose reduction of at least one chemotherapy drug (toxicity) and despite a higher proportion of substage b dogs undergoing therapy. We attribute the difference in death rate to careful staging that required the owners' commitment to therapy, as well as strict use of hospitalized induction for any animal that was in substage b.

We suggest that any dog that has signs compatible with substage b (particularly anorexia and other GI signs) be admitted for intravenous fluid therapy (maintenance x 1.5), broad-spectrum antibiotics (cefazolin sodium or enrofloxacin), and GI prophylaxis (metoclopramide and bland diet). This supportive care should be continued for at least 4 days after induction and preferably for a week. Dogs can be discharged to the owner as soon as they are self-supporting. Antibiotics and prophylactic metoclopramide are continued for the first 3 weeks of the protocol.

In addition, in one study, administration of trimethoprim/sulfadiazine (Tribrissen®) to dogs for 14 days, starting on the day of treatment with doxorubicin, markedly reduced the likelihood of GI toxicity (vomiting or diarrhea), hospitalization, and lower quality-of-life (Karnofsky) score. The effect was most marked in dogs with lymphoma and may be due to reduced bacterial translocation in damaged intestinal epithelial layers.(13)

Nutrition is an important part of supportive care for any dog with cancer, particularly for dogs with a systemic disease like lymphoma. Lactate and insulin concentrations in untreated dogs with lymphoma are higher than in dogs without lymphoma and do not improve when dogs enter chemotherapy-induced remission.(12-13)

Nutrition may also play a role in prolonging remission and survival. Polyunsaturated n-3 fatty acids have been shown to inhibit the growth and metastasis of tumors. In one study, 32 dogs with lymphoma were randomized to receive a diet supplemented with polyunsaturated n-3 fatty acids (menhaden fish oil and arginine) or an otherwise identical diet supplemented with soybean oil.(14) Diets were fed from the start of doxorubicin chemotherapy and continued after remission was attained. Dogs fed the diet supplemented with n-3 fatty acids had higher serum levels of n-3 fatty acids (docosahexaenoic acid and eicosapentaenoic acid) and lower plasma lactate responses to carbohydrate testing. Increased serum levels of docosahexaenoic acid were associated with longer remission and survival times for dogs with stage III lymphoma.