Lautscham E M, Kessler M, Ernst T, Willimzig L, Neiger R
Small Animal Clinic Hofheim, Katharina-Kemmler-Str. 7, Hofheim 65719, Germany.
Small Animal Clinic, Internal Medicine, Justus-Liebig-University Giessen, Frankfurter Str. 126, Giessen 35392, Germany.
Vet Rec. 2017 Mar 25;180(12):303. doi: 10.1136/vr.104077. Epub 2017 Jan 18.
The recommendation to treat canine lymphoma with a discontinuous protocol is based on small case numbers and mostly historic controls. This study compares duration of first remission (DFR) and overall survival time (ST) with a discontinuous protocol to the same protocol with maintenance phase. 408 dogs were treated with a CHOP-LAsp (C=cyclophosphamide; H=hydroxydaunorubicin; O=Oncovin; P=prednisolone; LAsp=l-asparaginase)-based 28-week induction protocol. In 75 dogs (cohort 1), this was followed by a maintenance phase consisting of vincristine, chlorambucil and actinomycin-D with a total treatment duration of two years. In the subsequent 333 dogs, therapy was discontinued after induction (cohort 2). Median DFR and ST in cohort 1 were 216 and 375 days and 184 and 304 days in cohort 2. 6-Month, 1-year and 2-year survival rates in cohort 1 were 73 per cent, 50 per cent, 24 per cent and 67 per cent, 39 per cent, 21 per cent in cohort 2. There was no significant difference between the two protocols (P=0.291 for ST, P=0.071 for DFR). On multivariate analysis, corticosteroid pretreatment (P=0.005), thrombocytopenia at diagnosis (P=0.019), stage (P=0.009), substage b at relapse (P<0.001), age (P=0.002) and incomplete or unstable remission necessitating intensification of therapy (P=0.004) were negatively correlated with ST in both groups. This study supports the use of a discontinuous protocol for canine multicentric lymphoma.
关于采用间断方案治疗犬淋巴瘤的建议是基于少量病例数且大多为历史对照。本研究比较了采用间断方案与采用含维持期的相同方案时首次缓解持续时间（DFR）和总生存时间（ST）。408只犬接受了基于CHOP-LAsp（C = 环磷酰胺；H = 羟基柔红霉素；O = 长春新碱；P = 泼尼松龙；LAsp = L-天冬酰胺酶）的28周诱导方案治疗。在75只犬（队列1）中，随后是由长春新碱、苯丁酸氮芥和放线菌素-D组成的维持期，总治疗持续时间为两年。在随后的333只犬中，诱导治疗后停止治疗（队列2）。队列1的中位DFR和ST分别为216天和375天，队列2为184天和304天。队列1的6个月、1年和2年生存率分别为73%、50%、24%，队列2为67%、39%、21%。两种方案之间无显著差异（ST的P = 0.291，DFR的P = 0.071）。多变量分析显示，两组中皮质类固醇预处理（P = 0.005）、诊断时血小板减少（P = 0.019）、分期（P = 0.009）、复发时b期（P < 0.001）、年龄（P = 0.002）以及需要强化治疗的不完全或不稳定缓解（P = 0.004）与ST呈负相关。本研究支持对犬多中心淋巴瘤采用间断方案。
