>He has had the first course of treatment - vincristine, followed by
>asparaginase and Pred. Then two more agents will be introduced, for a
>total of 10 weeks then "we'll see". Is there any hope - does anyone talk
>of remission or cure, with a white count this high? Any way to determine
>a prognosis, how long he might live ? Right now he continues to be very
>lethargic (probably the chemo and cell destruction), but is eating. He
>is also on Pred, Clavamox and Carafate.
 
Dr. Bruce Williams replies:
 
I am familiar with this protocol.  Unfortunately, there is little talk of
a remission or cure, especially when the neoplasm is leukemic (meaning that
the neoplastic cells are in the bloodstream), then the cases are extremely
difficult.
 
The biggest problem with leukemia is that the cells are not only in the
bloodstream, but they are also in the bone marrow as well.  In high
numbers, they crowd out the cells that normally produce blood elements -
RBC, white blood cells, and platelets - so on top of the neoplasm,
these animals often develop a life-threatening anemia.  When you add
chemotherapeutic agents on top fo this to kill the neoplastic cells, you
may further depress normal bone marrow output - as you might surmise, not
a high rate of success.
 
Right now, judging from the data, the RBC's appear okay, but the platelets
are on the low side.  This may pick up as occasionally vincristine has been
used to increase platelet function in some cases.
 
Overall, sustained response to chemo is probably seen in less than 10% -
most animals survive 2-4 months, but in all truth, that high a white counts
does not bode well even for that short period of time.  I'm keeping my
fingers crossed, but I always give a poor prognosis in any case of
lymphoma, and I am rarely proved wrong.
 
With kindest regards,
Bruce Williams, DVM, DACVP
 
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[Posted in FML issue 3356]