Big Boy - Lymphoma

Addisons · Cushings · Diabetes
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CavyHouse

Post   » Sat May 23, 2009 7:04 pm


Lymphoma / Lymphosarcoma
Name: Big Boy
Sex: Male, intact
Age at onset : Older adult (rescue) - Thick, curly nails

General History: 3/10/09 - 3 lbs. Left in night drop box at shelter. Shelter vet noted on 3/11/09 pinna acaley [Pinna is outer ear; not sure what acaley is], skin generally pinkish and very erythema [ redness of the skin caused by capillary congestion] on ventral abdomen with dried yellowish material in hair. Firm swelling ventral chin/neck ~1 cm diam. Unable to do FNA [fine needle aspirate]because wiggling too much. Impacted. Need rescue: skin and stool issues, lump on neck.

3/16/09 - 2# 15 oz. Shelter vet noted watery eyes,. Skin scald - scaly and red. Urine/fecal incontinence. Recommend euthanasia if can't find rescue today.

3/18/09 - Rescued from shelter. 1380 grams.

3/20/09 - Vet thought looked generally good. Took aspirate under chin.

3/22/09- Aspirate came back pus. Cervical lympadenitis. Treat with antibioitcs 10 days. Treatment completed with successful outcome.

Signs of Illness:

4/4/09 - Noticed swollen glands under jaw, inguinal glands quite swollen. Called vet. Continue antibiotics until appointment on 4/7/09

Veterinary visits and Treatments:

4/7/09 - Vet recheck: Weight: 2.6 lbs.
PE: Enlarged submandibular, right axillary and both inguinal lymph nodes.
Cyto: (FNA) large population of mononuclear cells.
CE: Looks like lymphoma. Options: Keep comfy, prednisone or chemotherapy. Recommend chemo.
Treatment:
1) Diphenhydramine 0.05 ml SQ [sub-cutaneous]
2) Elspar (L-Asparginase) - (2000IU/ml): 0.75 mls SQ

4/10/09 - Has more lumps. Start Prednisone (20 mg #5, pred 100 mg + oralplus 9.0 mls + orasweet 1.0 mls 10 mg/ml - give 0.1 mls PO BID x 10 days then SID x 10 days.

4/30/09 - Recheck. Doing well. Lumps have gone down. Scabbing on hind legs.
Treatment: 1) Benadryl 15u sq @ 1105
2) L-Asparginase (2000u/ml): 0.75 mls SQ
Treat scabbing with TMS for 7 days.

5/21/09 - Recheck at vet. Doing well. Lumps are gone. Scabbing on legs is gone. Still on Prednisone.
Weight: 1348 grams.
Exam: No palpable lymph nodes (!!!!!!)
Treatment:
1) Dephenhydramine 0.15 mls SQ
2) L-Asparginase (2000u/ml): 0.75 mls SQ
Next dose in 3 weeks.

5/22/09 - (Personal notes) Big Boy continues to look great 6 weeks post-diagnosis. He popcorned twice tonight - all 1320 grams of him! He has got one of the best personalities we've seen and is a big lover. Here he is enjoying an afternoon break.
Image

6/4/09- Big Boy continues to look great with no signs of lymphoma. He is now playing "uncle" to 3 newly weaned male pups and is enjoying it. Next treatment due 6/11/09/.

I recently spoke with another vet at another clinic who has used L-Asparginase and Prednisone along with another drug in treating lymphoma in a piggy. (We take our peafowl to this vet). He cited 9 months of symptom-free life before the piggy no longer responded to the drugs. He said he does want to write up his protocol. I'm hopefully going to get more details so I can share it.

6/10/09 - Big Boy had his re-check at the vet today along with his 4th round of chemo. He continues to show no signs of lymphoma - no palpatable lumps. He lost a few grams (<20). He eats and drinks a lot and is in very good spirits. He continues to seek out loves and scritches. This marks 9 weeks since his diagnosis. Our vet mentioned this is the longest survival that he's seen in his practice of a piggy with lymphoma.

6/23/09- Noted a couple lesions on Big Boy. Quarter sized papular lesion on the ventral surface at clavicle level, red and crusted. Along the same plane on the left lateral is a similar dime sized lesion. Crusty material on right pinna had some irriation that is not paylar.

6/25/09- Big Boy had a veterinary check today. He has lost around 60 grams. He doesn't seem as energetic lately. The lesion on his chest was not much of a concern. Did a scraping of the ear though. Possible causes are lymphocytes, fungal or mites. Initial exam for lymphocytes were negative but vet noted it's not a good test for it and may require a biopsy later. He suspects a fungal cause and will let me know what the results of the test are. Big Boy is to be treated with Clonofite cream BID.
6/27/09- Lesions on ear seem to be clearing up.

7/1/09- Big Boy had re-check and also his next round of chemo. He has put some weight back on and is eating well. He still seems to feel pretty good. He received L-Sparginase again and is continuing on the prednisone. The amounts he received are the same as the first treatments. This makes 12 weeks post-diagnosis. Ear lesions continue to improve and are almost gone.

7/10/09 - 13 weeks post-diagnosis. Right ear is all healed. Big Boy still doing well. Spends lots of time interacting with his girlfriend, Rosy, through the grids. Good spirits.

7/24/09 - 15 weeks! Big Boy just got another round of L-Sparginase. He will get two more doses spaced 3 weeks apart and then discontinue the L-Sparginase but continue the prednisone. The hope is that the lymphoma will be in remission.
He still looks great. He still isn't a big fan of afternoons and warm weather but seems very happy and is still very interactive with us.

8/14/09 - 18 weeks post-diagnosis! Big Boy went in for his exam and chemo today. He still has no signs of lymphoma and is still enjoying life. He continues to come out and see us to get his chin rubbed, is eating a ton and finds time for his girlfriend, Rosie. He received a L-Sparginase injection. The plan is still to have one more treatment in 3 weeks and then switch to prednisone only.

9/3/09- 21 weeks! Big Boy's exam and chemo went well today. He seems a little worn out this afternoon. I'm not sure if it's the chemo treatment today, warmer weather or ??

My vet and I discussed the treatment plan. When dogs and cats get lymphoma, my vet said that there are 4 chemo drugs that they treat with, cycling through all of them. 3 of these are intraveneous and so are difficult to administer to a guinea pig. I believe he said most protocols are for 6 months. 6 months for a guinea pig though are a much larger percent of a lifespan than it is for cat or dog.

There aren't many guinea pigs who have gone this far post-diagnosis so it's unclear how to proceed. My vet was going to research more to see if there are treatments that have worked for others. It's always a little scary discontinuing something that has been working but the hope is that the lymphoma is now in remission.

9/29/09-After consulting with the oncologist ( I believe at UC Davis), our vet has changed the protocol so that Big Boy will get chemo every 4 weeks, instead of every 3 weeks. He will receive his next dose on Thursday, October 1. He will still be getting the same dose and same drug.

10/29/09- Big Boy had another round of L-Sparginase and continues to get Prednisone twice a day. He remains symptom free and still looks in great shape. His appetite remains good and does not pass up on any vegetables and continues to eat lots of grass hay and timothy pellets daily.

11/6/09- Today marks 30 weeks and (knocking on wood) still symptom free. Big Boy is enjoying his chin rubs so much that all you have to do is show him your finger ready to scritch him and he'll come rumbling softly with his chin up so that he can get his rubs.

11/25/09 - Big Boy had his chemo a couple days early ( so he can enjoy Thanksgiving) and is still doing great. He continues his L-Sparginase every 4 weeks and Prednisone twice daily. He continues to look great and feel great with no palpable masses. I inquired to see if our vet has had any other lymphoma cases since Big Boy. He has not but said a couple of colleagues (sp?) of his had some hamsters with lymphoma but the owners declined treatment.

12/23/2009- Big Boy received another round of chemo and is doing great. He continues to show no signs of lymphoma or side effects from the chemo.

1/20/2010 - 43 weeks post-diagnosis. Once again Big Boy was treated with an injection of L-Sparginase and has been continuing with his twice daily doses of Prednisone. His physical examination showed no signs of reccurence. He has gained 50 grams in the past two weeks and is a svelte 1380 grams. Big Boy had a small cyst on his belly. A FNA was done and revealed it consisted of old blood and was not a concern.

2/17/2010 - 47 weeks; Big Boy had next round L-Sparginase. He was roughly 100 grams heavier than the previous appointment, roughly 1400 grams.

3/18/2010 - Big Boy was injected with l-Sparginase, as he has been every 4 weeks. He continues to look good.

I asked Dr. N about another guinea pig who recently had lymphoma and was not treated with L-Sparginase. He explained that Big Boy's lumps had come up very quickly from a very aggressive form of lymphoma. The L-SParginase works by killing fast-dividing cells, such as the aggressive lymphoma. Slower growing forms of it don't respond well to L-Sparginase because the cells don't divide quickly.

6/9/10 - I've missed a couple updates but things were going pretty much the same, i.e., Big Boy checked in great at his appointments and received his L-Sparginase. Today, however, Dr. N has decided to discontinue the L-Sparaginase injections but continue the prednisone. The hope is that Big Boy is in remission after 14 months of chemo. We will monitor his lymph nodes closely. We're hoping for good progress.

9/9/10 Big Boy gave us quite a scareas my son found a large lump under Big Boy's chin. It was the size of a large grape and somewhat hard. Early Friday, Big Boy saw Dr. Nakamura.

Dr. N. said Big Boy's lymph nodes under his legs were only mildly enlarged, if that. He aspirated the lump and knew immediately it was an abcess, as there was lots of pus. That was quite good news, but we still have to treat the abcess. Dr. N thought that the long-term steroids probably depress Big Boy's immune system.

Big Boy has lost some weight the past few weeks (80 grams) which we attribute to the increased exercise he's been getting now that he shares a cage with Rosie. He still has a great appetite.

2/2/2011- Big Boy continues to do well. He is still on the Prednisone. He has also been on Baytril for a few months in order to hopefully clear up the abcess under his chin without surgery.

5/8/2011 - Big Boy passed away today. Cause of death does not appear to be lymphoma. We miss Big Boy and feel very lucky to have had him for two years. We hope other piggies will benefit from sharing his story.

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Addendum:

12/21/2012 :: TWP_2 writes that according to these sites, the manufacturer in Denmark suspended production of L-Asparaginase (Elspar, L-spar) chemotheraputic agent mentioned above in December 2012, and all remaining supplies are allocated for human use.

https://www.ashp.org/DrugShortages/NotAvailable/bulletin.aspx?id=958

http://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM321556.pdf

According to a vet oncologist, there are no other equivalents. However, there are two possible substitutes mentioned at the ASHP site, Oncaspar and Erwinaze. TWP_2 does not know if either of those is a good substitute for L-Asparaginase (Elspar, L-spar). Per Big Boy's archive post, L-Asparaginase (Elspar, L-spar) is well tolerated and effective against (at least some) lymphoma.

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