Allogeneic hematopoietic cell transplantation in a dog with acute large granular lymphocytic leukemia.

CASE DESCRIPTION: A 3-year-old 10-kg (22-lb) neutered male Cavalier King Charles Spaniel was referred because of an episode of acute vomiting and diarrhea. CLINICAL FINDINGS: On physical examination, mild splenomegaly and prominent submandibular and popliteal lymph nodes were detected. Complete blood cell count revealed a high WBC count, characterized by a moderate lymphocytosis with 62% unclassified cells and severe thrombocytopenia with macroplatelets. On cytologic evaluation, the unclassified cells were described as large, neoplastic lymphoid cells containing a large nucleus with lacy chromatin and a large amount of blue vacuolated cytoplasm containing sparse, very fine azurophilic granules. A diagnosis of acute large granular lymphocytic leukemia of splenic origin was made. TREATMENT AND OUTCOME: Following induction chemotherapy, the affected dog underwent allogeneic hematopoietic cell transplantation with dog leukocyte antigen-matched CD34+ cells harvested from a sibling of the same litter. Chimerism analysis revealed full donor engraftment within 2 weeks after transplantation that remained stable for at least 2 years, with the dog remaining apparently healthy at home. CLINICAL RELEVANCE: Acute leukemias in dogs are rapidly fatal diseases. If an appropriate donor can be located, allogeneic hematopoietic cell transplantation may offer a feasible treatment, although peripheral blood CD34+ cell harvesting requires the availability of cell separator machines and management of graft-versus-host disease with immunosuppressive agents.

Use of multigeneration-family molecular dog leukocyte antigen typing to select a hematopoietic cell transplant donor for a dog with T-cell lymphoma.

CASE DESCRIPTION: A 7-year-old Golden Retriever was examined because of anorexia, lethargy, vomiting, and gradual weight loss. CLINICAL FINDINGS: Splenomegaly, pancytopenia, high serum calcium concentration, and high alkaline phosphatase activity were detected. Magnetic resonance imaging revealed an enlarged mesenteric lymph node and increased signals from the bone marrow of the ilium and vertebral bodies. Histologic examination and immunophenotyping of biopsy specimens confirmed a stage V (b) T-cell malignant lymphoma. TREATMENT AND OUTCOME: Clinical remission was attained by use of 2 chemotherapy cycles, followed by an allogeneic hematopoietic cell transplant performed at 18 weeks after diagnosis. A donor was identified by molecular dog leukocyte antigen typing methods. The patient was conditioned with 2 fractions of 4 Gy total body irradiation delivered 3 hours apart at 7 cGy/min, followed by an IV infusion of recombinant canine granulocyte colony-stimulating factor mobilized leukapheresis product and postgrafting immunosuppression with cyclosporine. Chimerism analyses revealed full donor engraftment that has been maintained for at least 58 weeks after transplant. Remission has been confirmed by normal results of serum thymidine kinase assays and the absence of peripheral blood clonal T-cell receptor gene rearrangements. CLINICAL RELEVANCE: Systemic chemotherapy induces remissions; however, most dogs succumb to disease recurrence because of multidrug resistance. Outcome of allogeneic hematopoietic cell transplantation in dogs can be excellent because of improved donor-recipient selection by use of molecular dog leukocyte antigen typing, compared with early attempts, and better prevention of graft versus host disease, better supportive care, and substitution of peripheral blood mononuclear cells for bone marrow.