Alternating Rabacfosadine/Doxorubicin: Efficacy and Tolerability in Naïve Canine Multicentric Lymphoma.

BACKGROUND: Standard of care treatment for multicentric lymphoma in dogs remains doxorubicin (DOX)-based combination chemotherapy, but owners may hesitate to commit the time and financial resources to complete such a protocol, typically requiring 12-16 visits. Rabacfosadine (RAB), a double prodrug of the nucleotide analog 9-(2-phosphonylmethoxyethyl) guanine, has substantial single-agent activity in dogs with lymphoma, and a different mechanism of action than DOX. HYPOTHESIS/OBJECTIVES: Our objective was to evaluate the efficacy and adverse effect (AE) profile of alternating doses of RAB and DOX in dogs with naïve multicentric lymphoma. ANIMALS: Fifty-four dogs with previously untreated lymphoma. METHODS: Open-label, multicenter prospective clinical trial. Dogs received alternating RAB (1.0 mg/kg IV weeks 0, 6, 12) and DOX (30 mg/m2 IV weeks 3, 9, 15). Dogs that achieved complete response (CR) were followed by monthly evaluations. Complete clinicopathological evaluation and assessment of remission and AEs were performed every 21 days. RESULTS: The overall response rate was 84% (68%; CR; 16%; partial response [PR)]. The overall median progression-free interval (PFI) was 194 days (216 for CR and 63 for PR). Most AEs were mild and self-limiting: gastrointestinal and hematologic AEs were most common. Thirteen dogs experienced dermatologic AEs, and 2 dogs developed grade 5 pulmonary fibrosis. CONCLUSIONS AND CLINICAL IMPORTANCE: Alternating RAB/DOX generally was well tolerated and resulted in PFIs comparable to standard DOX-based multi-agent protocols, with fewer treatment visits. Most adverse events were mild or moderate and self-limiting. Further studies are warranted to explore long-term outcome and other RAB chemotherapy combinations.

Immunophenotypic characterization of canine lymphoproliferative disorders.

One hundred ninety six dogs with spontaneously occurring lymphoproliferative disorders were immunophenotyped. Dogs with lymphoma (175) were determined to be derived from B-cells in 134/175 (76%), T-cells in 38/175 (22%) and 3/175 (2%) were null cells (non-reactive with any canine-specific lymphocyte antibody). Dogs with T-cell lymphomas were at significantly higher risk of relapse and early death compared with B-cell lineage lymphoma following therapy (52 vs. 160 days; p < 0.001 and 153 vs. 330 days; p < 0.001, respectively). Hypercalcemia was associated only with CD4+ lymphomas. A nonimmunoglobulin B-cell marker (B5), expressed in 95% of nonneoplastic lymphocytes, was expressed at a reduced level in 63% (64/104) of dogs with B-cell lymphoma. Dogs with lymphoma in which the B5 antigen was expressed below normal levels experienced shorter progression free survival (125 vs. 202 days; p < 0.05) and overall survival times (203 vs. 385 days; p < 0.05) than dogs with B-cell lymphoma in which the B5 antigen was expressed normally. Chronic lymphocytic leukemia in dogs was primarily associated with a CD8+ phenotype (8/12) and acute lymphoblastic leukemia was determined to be of either null cell (4/9) or T-cell (3/9) phenotype. Although canine and human non-Hodgkin's lymphoma are phenotypically similar, canine leukemia is phenotypically distinct from human leukemia. The development of canine-specific probes has facilitated a priori assessment of treatment outcome in dogs with lymphoma and may in the future contribute to the comparative understanding of leukemo- and lymphoma-genesis in these species.