Polychemotherapy regimens for the treatment of high-grade lymphoma in the cat.
Doxorubicin as monochemotherapy
|
Drug |
Administration protocol |
|
Doxorubicin |
25 mg/m2 or 1 mg/kg i.v. every 3 weeks for 5 doses. |
COP
|
Drug |
Induction (4 weeks) |
Maintenance (up to 1 year) |
|
Vincristine |
0.75 mg/m2 i.v. once a week (day 1) for 4 weeks. |
0.75 mg/m2 i.v. once every 3 weeks (day 1) until recurrence or up to a maximum of 1 year. |
|
Cyclophosphamide |
300 mg/m2per os: week 1 (day 1) and week 4 (day 1). |
300 mg/m2per os: once every 3 weeks (day 2) until recurrence or up to a maximum of 1 year. |
|
Prednisolone |
50 mg/m2per os s.i.d. |
Same dose until recurrence or up to a maximum of 1 year, then start tapering down and suspend within 3 weeks. |
CHOP
|
Drug |
Induction (4 weeks) |
Maintenance (up to 6 months) |
|
Vincristine |
0,75 mg/m2 i.v. once a week (day 1) for 4 weeks. |
|
|
Cyclophosphamide |
300 mg/m2per os: week 1 (day 1) and week 4 (day 1). |
|
|
Prednisolone |
50 mg/m2per os s.i.d. |
|
|
Doxorubicin |
|
25 mg/m2 or 1 mg/kg i.v. every 3 weeks. |
VCM
|
Drug |
Induction (4 weeks) |
Maintenance** |
|
Vincristine |
0.025 mg/kg i.v. weeks 1 and 3. |
Same administration protocol. |
|
Cyclophosphamide |
10 mg/kg i.v. week 2. |
Same administration protocol. |
|
Methotrexate |
0.8 mg/kg per os/i.v. week 4. |
Same administration protocol. |
|
Prednisone |
5 mg/cat per os s.i.d. |
Same administration protocol. |
VCM with L-asparaginase
|
Drug |
Induction (8 weeks) |
Maintenance |
|
L-asparaginase |
400 UI/kg i.p. week 1. |
|
|
Vincristine |
0.025 mg/kg i.v. weeks 1, 3, 5 and 8. |
Same dose but at intervals of 10 days for another eight treatments, then at intervals of 14 days for another 7 months. |
|
Cyclophosphamide |
10 mg/kg i.v. weeks 2 and 6. |
Same dose but at intervals of 10 days for another eight treatments, then at intervals of 14 days for another 7 months. |
|
Methotrexate |
0.8 mg/kg per os/i.v. weeks 4 and 8. |
Same dose but at intervals of 10 days for another eight treatments, then at intervals of 14 days for another 7 months. |
|
Prednisone |
2 mg/kg per os s.i.d. |
Continue at 2 mg/kg per os s.i.d. for 1 year, then halve the dose and administer it at intervals of 3 weeks. |
AMC
|
Drug |
Induction (14 weeks) |
|
L-asparaginase |
400 UI/kg i.m. week 1. |
|
Vincristine |
0.025 mg/kg i.v. weeks 1, 4, 8 and 12. |
|
Cyclophosphamide |
10 mg/kg i.v. weeks 2, 5 and 10*. |
|
Doxorubicin |
1 mg/kg i.v. weeks 3 and 6. |
|
Prednisone |
5 mg per os b.i.d. |
|
Methotrexate |
0,8 mg/kg i.v. week 14. |
Madison-Wisconsin protocol
|
Drug |
Induction (10 weeks) |
Maintenance |
|
L-asparaginase |
400 UI/kg i.m. week 1. |
|
|
Vincristine |
0.025 mg/kg or 0.5-0.7 mg/m2 i.v. weeks 1, 3, 6 and 8. |
0.025 mg/kg or 0.5-0.7 mg/m2 i.v. weeks 11, 15, 19 and 23. |
|
Cyclophosphamide |
200-250 mg/m2 i.v. weeks 2 and 7. |
|
|
Prednisone |
2 mg/kg per os s.i.d. for 14 days, then 1 mg/kg s.i.d. |
1 mg/kg per os s.i.d. |
|
Doxorubicin |
20-25 mg/m2 i.v. weeks 4 and 9. |
20 mg/m2 i.v. week 25. |
|
Methotrexate |
|
0.5-0.8 mg/kg i.v. week 17. |
|
Chlorambucil |
|
1.4 mg/kg per os: weeks 13 and 21 |
Modified Madison-Wisconsin protocol
|
Drug |
Administration protocol |
|
L-asparaginase |
400 UI/kg s.c. week 1. |
|
Vincristine |
0,5-0,7 mg/m2 i.v. weeks 1, 3, 6, 8, 11, 15, 19 and 23. |
|
Cyclophosphamide |
200 mg/m2 i.v. weeks 2, 7, 13 and 21. |
|
Prednisone |
2 mg/kg per os s.i.d. for 14 days, then 1 mg/kg s.i.d. for 7 days, then 1 mg/kg on alternate days. |
|
Doxorubicin |
25 mg/m2 i.v. weeks 4, 9, 17 and 25. |
VELCAP-C
|
Drug |
Administration protocol |
|
Doxorubicin |
25 mg/m2 i.v. weeks 1, 4, 15, 18, 21 and 24. |
|
Vincristine |
0,5-0,7 mg/m2 i.v. weeks 1, 2, 3, 7, 12, 11, 15, 19 and 23. |
|
Cyclophosphamide |
300 mg/m2per os weeks 7 and 12. |
|
L-asparaginase |
400 UI/kg s.c. weeks 8 and 9. |
|
Prednisone |
40 mg/m2per os s.i.d. for 7 days, then on alternate days. |
CHOP-based protocol with maintenance
|
Drug |
Administration protocol (induction) |
|
L-asparaginase |
400 UI/kg s.c. week 1. |
|
Vincristine |
0,025 mg/kg i.v. weeks 1 and 4. |
|
Cyclophosphamide |
10 mg/kg i.v. weeks 2 and 5. |
|
Doxorubicin |
1 mg/kg i.v. weeks 3 and 6. |
|
Prednisone |
2 mg/kg for 7 days, then 1.5 mg/kg for 7 days, then 1 mg/kg for 7 days, then 0.5 mg/kg for 7 days. |
Suggested readings
- otter SM: Treatment of lymphoma and leukaemia with cyclophosphamide, vincristine and prednisone: II. Treatment f cats. J Am Anim Hosp Assoc, 19: 166, 1983.
- Fan TM, Kitchell BE, Dhaliwal RS et al: Hematological toxicity and therapeutic efficacy of lomustine in 20 tumor-bearing cats: critical assessment of a practical dosing regimen.J Am Anim Hosp Assoc, 38: 357, 2002.
- Hadden AG, Cotter SM, Rand W, et al. Efficacy andtoxicosis of VELCAP-C treatment of lymphoma in cats.J Vet Intern Med. 22: 153, 2008.
- Jeglum KA, Whereat A, YoungK: Chemotherapy of lymphoma in 75 cats.J Am Vet Med Assoc, 190: 174, 1987.
- Kristal O, Lana SE, Ogilvie GK et al: Single agent chemotherapy with doxorubicin for feline lymphoma: a retrospective study of 19 cases (1994-1997).J Vet Intern Med, 15: 125, 2001.
- Milner RJ, Peyton J, Cooke K et al: Response rates and survival times for cats with lymphoma treated with the University of Wisconsin-Madison chemotherapy protocol: 38 cases (1996-2003).J Am Vet Med Assoc. 227: 1118, 2005.
- MooneySC, Hayes AA, MacEwen EG et al: Treatment and prognostic factors in lymphoma in cats: 103 cases (1977-1981).J Am Vet Med Assoc, 194: 696, 1989.
- MooreAS, Cotter SM, Frimberger AE, et al: A comparison of doxorubicin and COP for maintenance of remission in cats with lymphoma.J Vet Intern Med, 10: 372, 1996.
- Oberthaler KT, Mauldin E, McManus PM et al: Rescue therapy with doxorubicin-based chemotherapy for relapsing or refractory feline lymphoma: a retrospective study of 23 cases.J Feline Med Surg. 11: 259, 2009.
- Rassnick KM, Gieger TL, Williams LE, et al:Phase I evaluation of CCNU (lomustine) in tumor-bearing cats.J Vet Intern Med, 15: 196, 2001.
- Simon D, Eberle N, Laacke-Singer L, Nolte I.Combination chemotherapy in feline lymphoma: treatment outcome, tolerability, and duration in 23 cats. J Vet Intern Med. 22: 394, 2008.
- Stein TJ, Pellin M, Steinberg H, Chun R: Treatment of feline gastrointestinal small-cell lymphoma with chlorambucil and glucocorticoids. J Am Anim Hosp Assoc, 46:413, 2010.
- Teske E, van Straten G, van Noort R et al: Chemotherapy with cyclophosphamide, vincristine, and prednisolone (COP) in cats with malignant lymphoma: new results with an old protocol.J Vet Intern Med, 16: 179, 2002.
- Zwahlen CH, Lucroy MD, Kraegel SA, MadewellBR: Results of chemotherapy for cats with alimentary malignant lymphoma: 21 cases (1993-1997).J Am Vet Med Assoc, 213: 1144, 1998.