犬常见肿瘤的临床治疗
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• Prognostic importance预后的重要性
– negative prognostic factor负面预后因素 Rosenberg, 1991 n=37 remission duration (median)；平均缓解期
overall - 6 months (25% > 14 months) 全部-6个月(25% > 14个月) AMM - 3 months; no AMM - 8 months Weller, 1982 n=12 survival time - significantly shorter存活期-明显缩短
– myelosuppression and infection or sepsis骨髓抑制和感染或败血症 – anorexia and lethargy厌食、嗜睡 – nausea and vomiting恶心、呕吐 – diarrhea拉稀 – cardiotoxicity心脏毒性 – alopecia脱毛
– IgG or IgA monoclonal gammopathy IgG 或 IgA单克隆免疫球蛋白病
– radiographic evidence of osteolytic bone lesions X线片检查显示骨溶解
– > 10% neoplastic plasma cells in BM 骨髓中有> 10%肿瘤化的血细胞
– Urinalysis尿液分析 – Knott’s test for microfilaria那特氏检测微丝蚴 – chest and abdominal radiographs胸部和腹部X光片 – Electrocardiogram心电图 – bone marrow aspirate骨髓穿刺 – tissue biopsy for histopathology活组织组织病理学检查
a subunit of immunoglobulin a-免疫球蛋白 – Monoclonal gammopathy单克隆免疫球蛋白病 – Lytic bone lesions骨溶解
Multiple Myeloma 多发性骨髓瘤
Multiple Myeloma 多发性骨髓瘤
• Criteria (2 out of 4)标准（4种中至少2种）
“Typical” Presentation典型表现 Canine Lymphoma犬淋巴瘤
Canine Lymphoma犬淋巴瘤 Unusual Presentations罕见症状
Canine Lymphoma犬淋巴瘤 Clinical Evaluation临床评估
• recommended diagnostic testing建议进行的检查诊断 – complete blood count and biochemical profile全血计数和血液生化检 测
Lymphoproliferative disorders 淋巴组织增殖性疾病
• Disorders of Lymphoid origin cells淋巴样组织细胞 疾病
– Multiple Myeloma多发性骨髓瘤 – Chronic Lymphocytic Leukemia慢性淋巴细胞白血病 – Acute Lymphoblastic Leukemia急性淋巴细胞白血病
Multiple Myeloma多发性骨髓瘤
• Plasma cell tumor – systemic浆细胞肿瘤—全身性 • Diagnostic criteria:诊断标准：
– Bone marrow infiltrate with neoplastic plasma cells 骨髓内肿瘤性血细胞浸润 – Bence Jones Proteinuria Bence Jones蛋白尿
involvement 很多涉及到纵膈的形式或者骨髓
Rosenberg, 1991 n=37 AMM = 43% BM involvement = 41% 41%涉及骨髓
Hypercalcemia and LSA高血钙和淋巴肉瘤 Thymic and Bone Marrow胸腺瘤和骨髓瘤
Lymphoma & Hypercalcemia 淋巴瘤和高血钙
Canine Lymphoma犬淋巴瘤 Clinical Evaluation临床评估
• physical examination findings 临床检查所见
– peripheral lymphadenopathy 周围淋巴结病 – splenomegaly and/or hepatomegaly脾肿大和/或肝肿大 – abdominal mass 腹部肿块 – pallor 苍白 – petechial or ecchymotic hemorrhage淤血点或淤血斑 – muscle wasting肌肉萎缩 – pleural or abdominal effusion胸腔或腹腔积液
• median survival times vary with chemotherapy protocol utilized平均生 存期受化疗方案应用的影响
Lymphoma & Hypercalcemia 淋巴瘤和高血钙
• Can be associated with any stage
可见于任何分期 • Many have mediastinal form or bone marrow
Pulmonary Mass肺部块状阴影
Cytologic Diagnosis of LSA
淋巴肉瘤细胞学检查
Sanctuary Site Canine Lymphoma犬淋巴瘤
Canine Lymphoma犬淋巴瘤 Clinical Staging临床分期
Stage I - single node involvement. 一期-涉及单个淋巴结 Stage II - multiple node involvement on one side of
Canine Lymphoma犬淋巴瘤
• commonly diagnosed malignancy in dogs 在犬通常诊断为 恶性 – incidence 24/100,000 发病率24/100,000
• etiology unknown 机理不明 – genetic predisposition 遗传素质 • Bull Mastiff, Golden Retriever 马士提夫犬，金色寻 回猎犬 – environmental toxins 周围环境中的毒素 • 2,4-D – Retrovirus 反转录病毒
淋巴细胞增生性疾病
• Lymphoma淋巴瘤
– B-cell, T-cell
• Multiple Myeloma多发性骨髓瘤
– B-cell
• Plasmacytoma浆细胞瘤
– skeletal, extra-skeletal 骨骼的，骨骼外的
• Leukemia白血病
– acute lymphoblastic急性淋巴细胞白血病 – chronic lymphocytic慢性淋巴细胞白血病
diaphragm. 二期-涉及膈单侧的多个淋巴结 Stage III - generalized lymph node involvement. 三期-涉及全身淋巴结
Canine Lymphoma犬淋巴瘤 Clinical Staging临床分期
Stage IV - stages I through III with liver and/or spleen involvement. 四期 - 一期至三期涉及到肝脏和或脾脏 Stage V - stages I through IV with bone marrow involvement. 五期 – 一期至四期，涉及到骨髓
血浆细胞白血病
• Extramedullary plasmacytoma
浆细胞瘤
• Ehrlichia埃里希体
• FIP • Amyloidosis淀粉样变性 • Occult heartworm
disease潜在心丝虫疾病 • Plasmacytic enterocolitis
浆细胞性结肠炎 • Leishmaniasis利什曼病
Multiple Myeloma –Treatment 多发性骨髓瘤 - 治疗
• Chemotherapy化疗
day 1-10
Melphalan 0.1mg/kg PO q 24h
1-10天 美法仑 0.1mg/kg 口服 24h一次
day >11Melphalan 0.05mg/kg PO q 24h
• multiple factors may affect prognosis多种因素都可能影响预后
– histologic grade of malignancy恶性肿瘤组织学分级 – substage of disease疾病亚期 – Hypercalcemia低血钙 – response to therapy对治疗的反应 – chemotherapy protocol化疗方案 – gender性别
median survival 平均生存期
60 days 60 天 180 days 180 天 219 days 219 天 230 days 230 天 365 days 365 天
Canine Lymphoma犬淋巴瘤 Chemotherapy化疗
• potential toxicities associated with chemotherapy for lymphoma in dogs化学疗法治疗犬淋巴瘤的潜在毒性
substage (a) - no signs of systemic illness
亚期（a）-无全身病变症状
substage (b) - signs of systemic illness
亚期（b）-出现全身病变症状
Splenic Lymphoma 脾淋巴瘤
Canine Lymphoma犬淋巴瘤 Prognosis预后
Clinical Management of Common Canine Tumors
犬常见肿瘤的临床治疗
G. Neal Mauldin, DVM DACVIM (Internal Medicine and Oncology) DACVR (Radiation Oncology)
Lymphoproliferative Diseases
Canine Lymphoma犬淋巴瘤 Chemotherapy化疗
Protocol 方案
prednisone alone 单独使用泼尼松 COP chemotherapy COP 联合化疗 AMC cyclic protocol AMC 循环方案 doxorubicin alone 单独使用多柔比星 LSU protocol LSU 方案
Canine Lymphoma犬淋巴瘤 Clinical Signs临床症状
• peripheral lymphadenopathy 周围淋巴结病 • anorexia and lethargy 厌食、乏力 • weight loss 体重减轻 • evidence of hemorrhage 有出血的表现 • dyspnea 呼吸困难 • polyuria and polydipsia多尿、多饮 • vomiting and diarrhea 呕吐、拉稀
– Bence Jones proteinuria Bence Jones蛋白尿
Monoclonal Gammopathy
单克隆免疫球蛋白病
• Multiple myeloma多发性骨髓瘤 • Waldenstrom’s
Macroglobulinemia
Waldenstrom氏巨球蛋白血症
• Lymphoma淋巴瘤 • CLL慢性淋巴细胞白血病 • Plasma cell leukemwk.baidu.coma
11天之后 美法仑 0.05mg/kg 口服 24h一次
day 1-10
Pred 15mg/m2 PO q 24h
1-10天
泼尼松 15mg/ m2 口服 24h一次
day 11-60 Pred 15mg/m2 PO q 48h
– negative prognostic factor负面预后因素 Rosenberg, 1991 n=37 remission duration (median)；平均缓解期
overall - 6 months (25% > 14 months) 全部-6个月(25% > 14个月) AMM - 3 months; no AMM - 8 months Weller, 1982 n=12 survival time - significantly shorter存活期-明显缩短
– myelosuppression and infection or sepsis骨髓抑制和感染或败血症 – anorexia and lethargy厌食、嗜睡 – nausea and vomiting恶心、呕吐 – diarrhea拉稀 – cardiotoxicity心脏毒性 – alopecia脱毛
– IgG or IgA monoclonal gammopathy IgG 或 IgA单克隆免疫球蛋白病
– radiographic evidence of osteolytic bone lesions X线片检查显示骨溶解
– > 10% neoplastic plasma cells in BM 骨髓中有> 10%肿瘤化的血细胞
– Urinalysis尿液分析 – Knott’s test for microfilaria那特氏检测微丝蚴 – chest and abdominal radiographs胸部和腹部X光片 – Electrocardiogram心电图 – bone marrow aspirate骨髓穿刺 – tissue biopsy for histopathology活组织组织病理学检查
a subunit of immunoglobulin a-免疫球蛋白 – Monoclonal gammopathy单克隆免疫球蛋白病 – Lytic bone lesions骨溶解
Multiple Myeloma 多发性骨髓瘤
Multiple Myeloma 多发性骨髓瘤
• Criteria (2 out of 4)标准（4种中至少2种）
“Typical” Presentation典型表现 Canine Lymphoma犬淋巴瘤
Canine Lymphoma犬淋巴瘤 Unusual Presentations罕见症状
Canine Lymphoma犬淋巴瘤 Clinical Evaluation临床评估
• recommended diagnostic testing建议进行的检查诊断 – complete blood count and biochemical profile全血计数和血液生化检 测
Lymphoproliferative disorders 淋巴组织增殖性疾病
• Disorders of Lymphoid origin cells淋巴样组织细胞 疾病
– Multiple Myeloma多发性骨髓瘤 – Chronic Lymphocytic Leukemia慢性淋巴细胞白血病 – Acute Lymphoblastic Leukemia急性淋巴细胞白血病
Multiple Myeloma多发性骨髓瘤
• Plasma cell tumor – systemic浆细胞肿瘤—全身性 • Diagnostic criteria:诊断标准：
– Bone marrow infiltrate with neoplastic plasma cells 骨髓内肿瘤性血细胞浸润 – Bence Jones Proteinuria Bence Jones蛋白尿
involvement 很多涉及到纵膈的形式或者骨髓
Rosenberg, 1991 n=37 AMM = 43% BM involvement = 41% 41%涉及骨髓
Hypercalcemia and LSA高血钙和淋巴肉瘤 Thymic and Bone Marrow胸腺瘤和骨髓瘤
Lymphoma & Hypercalcemia 淋巴瘤和高血钙
Canine Lymphoma犬淋巴瘤 Clinical Evaluation临床评估
• physical examination findings 临床检查所见
– peripheral lymphadenopathy 周围淋巴结病 – splenomegaly and/or hepatomegaly脾肿大和/或肝肿大 – abdominal mass 腹部肿块 – pallor 苍白 – petechial or ecchymotic hemorrhage淤血点或淤血斑 – muscle wasting肌肉萎缩 – pleural or abdominal effusion胸腔或腹腔积液
• median survival times vary with chemotherapy protocol utilized平均生 存期受化疗方案应用的影响
Lymphoma & Hypercalcemia 淋巴瘤和高血钙
• Can be associated with any stage
可见于任何分期 • Many have mediastinal form or bone marrow
Pulmonary Mass肺部块状阴影
Cytologic Diagnosis of LSA
淋巴肉瘤细胞学检查
Sanctuary Site Canine Lymphoma犬淋巴瘤
Canine Lymphoma犬淋巴瘤 Clinical Staging临床分期
Stage I - single node involvement. 一期-涉及单个淋巴结 Stage II - multiple node involvement on one side of
Canine Lymphoma犬淋巴瘤
• commonly diagnosed malignancy in dogs 在犬通常诊断为 恶性 – incidence 24/100,000 发病率24/100,000
• etiology unknown 机理不明 – genetic predisposition 遗传素质 • Bull Mastiff, Golden Retriever 马士提夫犬，金色寻 回猎犬 – environmental toxins 周围环境中的毒素 • 2,4-D – Retrovirus 反转录病毒
淋巴细胞增生性疾病
• Lymphoma淋巴瘤
– B-cell, T-cell
• Multiple Myeloma多发性骨髓瘤
– B-cell
• Plasmacytoma浆细胞瘤
– skeletal, extra-skeletal 骨骼的，骨骼外的
• Leukemia白血病
– acute lymphoblastic急性淋巴细胞白血病 – chronic lymphocytic慢性淋巴细胞白血病
diaphragm. 二期-涉及膈单侧的多个淋巴结 Stage III - generalized lymph node involvement. 三期-涉及全身淋巴结
Canine Lymphoma犬淋巴瘤 Clinical Staging临床分期
Stage IV - stages I through III with liver and/or spleen involvement. 四期 - 一期至三期涉及到肝脏和或脾脏 Stage V - stages I through IV with bone marrow involvement. 五期 – 一期至四期，涉及到骨髓
血浆细胞白血病
• Extramedullary plasmacytoma
浆细胞瘤
• Ehrlichia埃里希体
• FIP • Amyloidosis淀粉样变性 • Occult heartworm
disease潜在心丝虫疾病 • Plasmacytic enterocolitis
浆细胞性结肠炎 • Leishmaniasis利什曼病
Multiple Myeloma –Treatment 多发性骨髓瘤 - 治疗
• Chemotherapy化疗
day 1-10
Melphalan 0.1mg/kg PO q 24h
1-10天 美法仑 0.1mg/kg 口服 24h一次
day >11Melphalan 0.05mg/kg PO q 24h
• multiple factors may affect prognosis多种因素都可能影响预后
– histologic grade of malignancy恶性肿瘤组织学分级 – substage of disease疾病亚期 – Hypercalcemia低血钙 – response to therapy对治疗的反应 – chemotherapy protocol化疗方案 – gender性别
median survival 平均生存期
60 days 60 天 180 days 180 天 219 days 219 天 230 days 230 天 365 days 365 天
Canine Lymphoma犬淋巴瘤 Chemotherapy化疗
• potential toxicities associated with chemotherapy for lymphoma in dogs化学疗法治疗犬淋巴瘤的潜在毒性
substage (a) - no signs of systemic illness
亚期（a）-无全身病变症状
substage (b) - signs of systemic illness
亚期（b）-出现全身病变症状
Splenic Lymphoma 脾淋巴瘤
Canine Lymphoma犬淋巴瘤 Prognosis预后
Clinical Management of Common Canine Tumors
犬常见肿瘤的临床治疗
G. Neal Mauldin, DVM DACVIM (Internal Medicine and Oncology) DACVR (Radiation Oncology)
Lymphoproliferative Diseases
Canine Lymphoma犬淋巴瘤 Chemotherapy化疗
Protocol 方案
prednisone alone 单独使用泼尼松 COP chemotherapy COP 联合化疗 AMC cyclic protocol AMC 循环方案 doxorubicin alone 单独使用多柔比星 LSU protocol LSU 方案
Canine Lymphoma犬淋巴瘤 Clinical Signs临床症状
• peripheral lymphadenopathy 周围淋巴结病 • anorexia and lethargy 厌食、乏力 • weight loss 体重减轻 • evidence of hemorrhage 有出血的表现 • dyspnea 呼吸困难 • polyuria and polydipsia多尿、多饮 • vomiting and diarrhea 呕吐、拉稀
– Bence Jones proteinuria Bence Jones蛋白尿
Monoclonal Gammopathy
单克隆免疫球蛋白病
• Multiple myeloma多发性骨髓瘤 • Waldenstrom’s
Macroglobulinemia
Waldenstrom氏巨球蛋白血症
• Lymphoma淋巴瘤 • CLL慢性淋巴细胞白血病 • Plasma cell leukemwk.baidu.coma
11天之后 美法仑 0.05mg/kg 口服 24h一次
day 1-10
Pred 15mg/m2 PO q 24h
1-10天
泼尼松 15mg/ m2 口服 24h一次
day 11-60 Pred 15mg/m2 PO q 48h