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Lecot L, Desmas‐Bazelle I, Benjamin S, De Fornel P, Ponce F, Kornya M, Desquilbet L, Beaudu‐Lange C, Ibisch C, Sayag D, Benchekroun G, Béguin J. Descriptive analysis and prognostic factors in cats with myeloma-related disorders: A multicenter retrospective study of 50 cases. J Vet Intern Med 2024; 38:1693-1705. [PMID: 38517293 PMCID: PMC11099758 DOI: 10.1111/jvim.17051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Myeloma-related disorders (MRDs) are rare and poorly documented neoplasms of cats. HYPOTHESIS/OBJECTIVES To describe clinical, clinicopathologic, and imaging findings, response to treatment, and survival time and to identify factors associated with shorter outcomes in cats with MRD. ANIMALS Fifty cats with a diagnosis of MRD. METHODS Cats with paraproteinemia confirmed by serum protein electrophoresis (SPE) and either intramedullary plasmacytosis >10%, marked cytonuclear atypia with intramedullary plasmacytosis that ranged between 5% and 10%, or cytologically or histologically confirmed visceral infiltration were retrospectively included from several veterinary referral centers. RESULTS Bone marrow plasmacytosis and splenic or hepatic involvement were present in 17/27 cats (63%), 36/42 cats (86%), and 27/38 cats (71%), respectively. Anemia was reported in 33/49 cats (67%) and thrombocytopenia in 16/47 cats (34%). Some of the treatments that the cats received included melphalan and prednisolone (n = 19), cyclophosphamide and prednisolone (n = 10), chlorambucil and prednisolone (n = 4), prednisolone (n = 4), or other (n = 4). The overall response rates to melphalan, cyclophosphamide, and chlorambucil in combination with prednisolone were 87%, 90%, and 100%, respectively. Adverse events to melphalan or cyclophosphamide occurred in 65% and 23% of cats, respectively. Median survival time was 122 days (range, 0-1403) and was not significantly associated with chemotherapy protocol. Anemia (hazard ratio [HR], 3.1; 95% confidence interval [CI], 1.0-9.8) and thrombocytopenia (HR, 2.7; 95% CI, 1.2-6.0) were risk factors for shorter survival. CONCLUSIONS AND CLINICAL IMPORTANCE Our study confirmed the guarded prognosis of MRD in cats and identified risk factors for shorter survival times.
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Affiliation(s)
- Lorris Lecot
- Ecole Nationale Vétérinaire d'Alfort–CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Université de Lyon, VetAgro Sup, Service de médecine interneMarcy l'EtoileFrance
| | | | | | | | - Frédérique Ponce
- Université de Lyon, VetAgro Sup, Service de cancérologie, UR ICEMarcy l'EtoileFrance
| | - Matthew Kornya
- Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Loïc Desquilbet
- Ecole nationale vétérinaire d'Alfort, IMRBMaisons‐AlfortFrance
| | | | - Catherine Ibisch
- Nantes‐Atlantic College of Veterinary Medicine and Food Sciences (Oniris)NantesFrance
| | | | - Ghita Benchekroun
- Ecole Nationale Vétérinaire d'Alfort–CHUVAService de Médecine InterneMaisons‐AlfortFrance
- Ecole Nationale Vétérinaire d'AlfortUniversité Paris Est Créteil, INSERM, IMRBMaisons‐AlfortFrance
| | - Jérémy Béguin
- Ecole Nationale Vétérinaire d'Alfort–CHUVAService de Médecine InterneMaisons‐AlfortFrance
- UMR1161 VIROLOGIE, INRAE, Ecole Nationale Vétérinaire d'Alfort, ANSESUniversité Paris‐EstMaisons‐AlfortFrance
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Amalbert T, Canonne AM, Béguin J. Myelomatous pleural effusion in a cat diagnosed with multiple myeloma. JFMS Open Rep 2023; 9:20551169221134094. [PMID: 36755800 PMCID: PMC9899953 DOI: 10.1177/20551169221134094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Case summary A 10-year-old male castrated domestic shorthair cat was presented with a 3-day history of dyspnoea, chronic lethargy and inappetence. A bilateral pleural effusion was identified by thoracic ultrasound, and cytological examination revealed numerous atypical plasma cells. Biochemistry and serum protein electrophoresis revealed a severe hyperglobulinaemia associated with a monoclonal gammopathy. A moderate non-regenerative anaemia was also noted. Multiple bone lytic lesions were detected, and marked plasmacytosis was observed on bone marrow aspirates. Chemotherapy with cyclophosphamide and prednisolone was initiated but did not result in any clinical or biological response, and pleural effusion recurred. Lack of therapeutic response led to euthanasia 2 months after diagnosis. Relevance and novel information This is the first description of a myelomatous pleural effusion in a cat diagnosed with multiple myeloma and should be considered as one of the possible differential diagnoses for cats presented with pleural effusion and hyperglobulinaemia. The diagnostic, therapeutic and prognostic aspects of this manifestation are discussed.
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Affiliation(s)
- Tancrède Amalbert
- National Veterinary School of Alfort,
Paris-Est University, Maisons-Alfort, France
| | - Aude Morgane Canonne
- Department of Internal Medicine,
National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort,
France,Aude Morgane Canonne DVM, DipECVIM-CA,
Department of Internal Medicine, National Veterinary School of Alfort, 7 Av. du
Général de Gaulle, Maisons-Alfort 94700, France
| | - Jérémy Béguin
- Department of Internal Medicine,
National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort,
France
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Tani H, Miyamoto R, Miyazaki T, Oniki S, Tamura K, Bonkobara M. A feline case of multiple myeloma treated with bortezomib. BMC Vet Res 2022; 18:384. [PMID: 36324112 PMCID: PMC9632122 DOI: 10.1186/s12917-022-03484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Multiple myeloma (MM) is an uncommon neoplasm in cats. There is no established standard of treatment due to the rare occurrence of this disease in cats. Bortezomib is a proteasome inhibitor that serves as the first-line drug for MM in humans, but its effectiveness currently is unknown in feline MM. We present here the case report of a feline MM that exhibited a favorable response to bortezomib. Case presentation The case was an 11-year-old non-castrated male domestic cat with light-chain MM presenting with clinical symptoms (anorexia, fatigue, and vomiting), mild azotemia, and pancytopenia. The cat failed on melphalan with prednisolone (MP), so bortezomib (Velcade) was initiated on Day 88. A total of 6 cycles of the treatment was performed, with each treatment cycle consisting of twice-weekly subcutaneous administration for 2 weeks followed by a 1-week rest. The dose of bortezomib was 0.7 mg/m2 for first week and 1.0 mg/m2 for second week in the first cycle. A dose of 0.7 mg/m2 was used for subsequent cycles. Prednisolone was used concomitantly in the first 2 cycles. Following treatment with bortezomib, clinical symptoms disappeared and a decrease in serum globulin and recovery of pancytopenia were noted. A monoclonal gammopathy, overproduction of serum immunoglobulin light chain, and Bence-Jones proteinuria that existed at diagnosis were undetectable on Day 123. A monoclonal gammopathy also was not detectable at the end of the bortezomib treatment (Day 213). Anorexia, fatigue, and marked bone marrow toxicity were experienced when bortezomib was administrated at a dose of 1.0 mg/m2, while no recognizable toxicity was observed at a dose of 0.7 mg/m2 throughout the treatment period. The case was placed on follow-up and there was no evidence of relapse as of Day 243. Conclusions Bortezomib was effective and durable for the treatment of this case of feline MM after failure with MP. Bortezomib was well-tolerated in this cat at a dose of 0.7 mg/m2, but not at 1.0 mg/m2. Bortezomib appears to be a drug worthy of further study for the treatment of feline MM. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-022-03484-1.
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Affiliation(s)
- Hiroyuki Tani
- grid.412202.70000 0001 1088 7061Department of Veterinary Clinical Pathology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Ryo Miyamoto
- grid.412202.70000 0001 1088 7061Department of Veterinary Clinical Pathology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Teruki Miyazaki
- grid.412202.70000 0001 1088 7061Department of Veterinary Clinical Pathology, Nippon Veterinary and Life Science University, Tokyo, Japan ,Musashikoganei haru dog and cat hospital, Tokyo, Japan
| | - Shingo Oniki
- Musashikoganei haru dog and cat hospital, Tokyo, Japan
| | - Kyoichi Tamura
- grid.412202.70000 0001 1088 7061Department of Veterinary Clinical Pathology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Makoto Bonkobara
- grid.412202.70000 0001 1088 7061Department of Veterinary Clinical Pathology, Nippon Veterinary and Life Science University, Tokyo, Japan ,grid.412202.70000 0001 1088 7061Research Center for Animal Life Science, Nippon Veterinary and Life Science University, Tokyo, Japan
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Palić J, Heier A, Lehmbecker A, Baumgärtner W, Turba ME. A challenging case of lymphoproliferative disease in a cat. Vet Clin Pathol 2022; 51:263-268. [PMID: 35181934 DOI: 10.1111/vcp.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
A 7-year-old male castrated Maine Coon cat presented with edema of the right hindlimb and a markedly enlarged right popliteal lymph node. A CBC showed a neutropenia of 1.5 × 103 /μL. Radiographs and ultrasonographic examination were unremarkable. Cytology of the right popliteal lymph node revealed a mixed population of cells, consisting predominantly of medium to large plasmacytoid lymphocytes, low to moderate numbers of well-differentiated plasma cells and low numbers of small lymphocytes. Plasmacytoid lymphocytes had round nuclei with finely stippled chromatin and one prominent round nucleolus. Low numbers of binucleated cells and bizarre mitotic figures, and rare multinucleated cells were observed. Histopathologic examination of the lymph node showed effacement of the normal lymph node architecture by dense sheets of neoplastic cells. Round to polygonal tumor cells of intermediate size had a low to moderate amount of cytoplasm. Round to indented hyperchromatic nuclei were often eccentrically located and contained one distinct nucleolus. Anisocytosis and anisokaryosis were moderate and 21 mitoses/10 high power field (HPF) were present. Congo red staining was negative. High numbers of tumor cells were positive for lambda light chain immunoglobulin; moderate numbers stained positive for MUM-1. A clonal BCR gene rearrangement was detected with an immunoglobulin heavy chain target (IGH), immunoglobulin lambda light chain (IgL), and kappa deleting element (Kde). Differential diagnoses for the lymphoproliferative disease in this cat included lymphoplasmacytic lymphoma and myeloma-related disorder.
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Affiliation(s)
- Jelena Palić
- Vet Med Labor GmbH Division of IDEXX Laboratories, Kornwestheim, Germany
| | - Annabelle Heier
- Vet Med Labor GmbH Division of IDEXX Laboratories, Kornwestheim, Germany
| | - Annika Lehmbecker
- Department of Pathology, University of Veterinary Medicine, Foundation, Hannover, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine, Foundation, Hannover, Germany
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Moore TM, Thomovsky SA, Thompson CA, Heng HG, Bentley RT. Case Report: Suspected Solitary Osseous Plasmacytoma in a Cat: Use of Magnetic Resonance Imaging to Diagnose and Confirm Resolution of Disease Following Chemotherapy. Front Vet Sci 2021; 8:752279. [PMID: 34676257 PMCID: PMC8523671 DOI: 10.3389/fvets.2021.752279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
A 9-year-old female spayed Domestic Shorthair cat presented for pain, reluctance to jump, and hyporexia of 14 days duration. Neurologic examination was consistent with C6-T2 myelopathy. Magnetic resonance imaging (MRI) revealed a solitary, contrast-enhancing lesion within the T2 vertebral body. Solitary osseous plasmacytoma was diagnosed based on neurologic examination, advanced imaging, and clinicopathologic findings. Melphalan and prednisolone therapy were initiated. Complete resolution of clinical signs and the vertebral lesion were documented at a 2-year follow up examination with neurologic examination and repeat spinal MRI, respectively. Solitary osseous plasmacytoma are rare neoplasms in humans and domestic animals. As such, there is a paucity of published information regarding diagnostic criteria, MRI findings, treatment modalities, progression, and remission of disease in the feline patient. Most data are extrapolated from human medicine. The purpose of this report is to document neurologic exam and MR findings at the time of diagnosis and complete resolution of a solitary osseous vertebral plasmacytoma following melphalan and prednisolone therapy.
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Affiliation(s)
- Talisha M Moore
- Department of Veterinary Clinical Science, Purdue University, West Lafayette, IN, United States
| | - Stephanie A Thomovsky
- Department of Veterinary Clinical Science, Purdue University, West Lafayette, IN, United States
| | - Craig A Thompson
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, United States
| | - Hock Gan Heng
- Department of Veterinary Clinical Science, Purdue University, West Lafayette, IN, United States
| | - R Timothy Bentley
- Department of Veterinary Clinical Science, Purdue University, West Lafayette, IN, United States
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Kim C, Wouda RM, Borrego J, Chon E. Cyclophosphamide rescue therapy for relapsed low-grade alimentary lymphoma after chlorambucil treatment in cats. J Feline Med Surg 2021; 23:976-986. [PMID: 33645321 DOI: 10.1177/1098612x21996498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the response, outcome and prognostic factors in cats with clinically presumed relapsed low-grade alimentary lymphoma (LGAL) receiving cyclophosphamide as a first-line rescue therapy after failing chlorambucil treatment. METHODS The medical records of 20 cats (from three institutions, between 2002 and 2017) treated with cyclophosphamide for relapsed LGAL after initial treatment with chlorambucil were retrospectively reviewed. Progression-free survival (PFS), overall survival time (OST) and the association of select variables with measures of outcome were assessed. Adverse events (AEs) were also described. RESULTS Eighteen cats (90%) achieved a complete clinical response (CR) for a median duration of 239 days. The median PFS was 215 days. The median OST was 1065 days. The only clinical factor associated with a longer PFS was achievement of a CR with cyclophosphamide treatment. Cyclophosphamide was associated with few and reversible constitutional, gastrointestinal and hematologic AEs. CONCLUSIONS AND RELEVANCE Cyclophosphamide appears to be a safe and effective first-rescue therapeutic option for cats with relapsed LGAL.
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Affiliation(s)
- Changseok Kim
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Denney Veterinary Services, Vicksburg, MI, USA
| | - Raelene M Wouda
- Department of Clinical Sciences, Kansas State University, College of Veterinary Medicine, Manhattan, KS, USA
| | - Juan Borrego
- Hospital Aúna Especialidades Veterinarias, Valencia, Spain
| | - Esther Chon
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.,MedVet Indianapolis, Carmel, IN, USA
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Tamura Y, Chambers JK, Neo S, Goto-Koshino Y, Takagi S, Uneyama M, Uchida K, Hisasue M. Primary duodenal plasmacytoma with associated primary (amyloid light-chain) amyloidosis in a cat. JFMS Open Rep 2020; 6:2055116920957194. [PMID: 33014408 PMCID: PMC7513395 DOI: 10.1177/2055116920957194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Case summary A 14-year-old spayed female American Shorthair cat was presented with weight loss and a
palpable abdominal mass. Abdominal ultrasound and CT revealed a duodenal mass with
suspected perforation and an enlarged jejunal lymph node. Cytological evaluation from a
fine-needle aspiration of the abdominal mass displayed many atypical round cells, some
with a small amount of light pink material at the cellular edge. The duodenal mass was
surgically removed, and was diagnosed as a plasma cell tumour immunohistochemically
positive for CD79 alpha, IgA and lambda immunoglobulin light chains. In addition,
amyloidosis was detected. PCR to assess the antigen receptor rearrangement of the tumour
cells showed a monoclonal rearrangement of the immunoglobulin heavy chain gene.
Postoperatively, the cat received chemotherapy with cyclophosphamide and prednisolone.
Owing to progressive enlargement of the jejunal lymph node, different chemotherapy
protocols were used sequentially, namely chlorambucil, lomustine and L-asparaginase.
However, the cat died 96 days after the initial diagnosis. Post-mortem examination
confirmed systemic dissemination of tumour cells. The cause of death was considered to
be a result of a complication of the tumour itself and associated amyloidosis. Relevance and novel information This patient was diagnosed with a primary duodenal plasmacytoma, and primary (amyloid
light-chain) amyloidosis. In cats, intestinal plasmacytoma is rarely reported and
associated amyloidosis is an uncommon feature, when compared with humans. To our
knowledge, this is the first clinical report of duodenal plasmacytoma in a cat. The
present report shows that feline plasmacytomas should be included in the differential
diagnosis of a duodenal mass.
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Affiliation(s)
- Yu Tamura
- Veterinary Teaching Hospital, Azabu University, Kanagawa, Japan.,Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
| | - James K Chambers
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Science, Tokyo University, Tokyo, Japan
| | - Sakurako Neo
- Laboratory of Clinical Diagnosis, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
| | - Yuko Goto-Koshino
- Laboratory of Molecular Diagnostics, Veterinary Medical Center, Tokyo University, Tokyo, Japan
| | - Satoshi Takagi
- Laboratory of Small Animal Surgery, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
| | - Mizuho Uneyama
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Science, Tokyo University, Tokyo, Japan
| | - Kazuyuki Uchida
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Science, Tokyo University, Tokyo, Japan
| | - Masaharu Hisasue
- Laboratory of Small Animal Internal Medicine, School of Veterinary Medicine, Azabu University, Kanagawa, Japan
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9
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Fernández R, Chon E. Comparison of two melphalan protocols and evaluation of outcome and prognostic factors in multiple myeloma in dogs. J Vet Intern Med 2018; 32:1060-1069. [PMID: 29566439 PMCID: PMC5980396 DOI: 10.1111/jvim.15084] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/21/2017] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
Background Multiple myeloma (MM) in dogs typically is treated with melphalan. A daily melphalan dosing schedule reportedly is well tolerated and associated with favorable outcome. Although anecdotally a pulse dose regimen has resulted in successful responses, little long‐term outcome and safety data is available regarding this dosing regimen for dogs with MM. Hypothesis/objectives (1) To compare outcome and adverse event profiles between pulse dose and daily dose melphalan schedules and (2) to report prognostic factors in dogs with MM treated with melphalan. We hypothesized that both protocols would have similar outcomes and tolerability. Animals Thirty‐eight client‐owned dogs diagnosed with MM receiving pulse dose (n = 17) or daily dose (n = 21) melphalan. Methods Retrospective cohort study assessing outcome and adverse events in dogs receiving either protocol. Risk factors were evaluated for their prognostic relevance. Results Both regimens were well tolerated and similarly effective, with an overall median survival time of 930 days. Renal disease and neutrophil‐to‐lymphocyte ratio (NLR) were negative prognostic factors, whereas hypercalcemia and osteolytic lesions were not prognostic factors in this study population. Conclusions and Clinical Importance Positive results support the use of either dosing regimen for the treatment of dogs with MM, and renal disease and NLR were negative prognostic factors. Prospective, controlled, and randomized studies are warranted to confirm these findings.
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Affiliation(s)
- Ricardo Fernández
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, 53706
| | - Esther Chon
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, 53706.,Madison Veterinary Specialists, Madison, Wisconsin, 53713
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Burton JH, Knych HK, Stanley SD, Rebhun RB. Potency and stability of compounded formulations of chlorambucil, melphalan and cyclophosphamide. Vet Comp Oncol 2017; 15:1558-1563. [PMID: 28120478 DOI: 10.1111/vco.12301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral chemotherapy agents are frequently compounded in veterinary medicine however, the potency of some formulations have been shown to vary from that of Food and Drug Administration (FDA)-approved products. AIMS The objective of this study was to evaluate the potency and stability of three compounded oral chemotherapeutics commonly prescribed to be administered over time. MATERIALS & METHODS Compounded chlorambucil 1 mg, cyclophosphamide 5 mg and melphalan 1 mg were obtained and for potency tested upon receipt and 6 weeks later. RESULTS Potency ranged from 71 to 104% for chlorambucil and 58 to 109% for melphalan; 1/4 and 2/4 samples were <90% of labelled strength at baseline and 6 weeks, respectively, for both drugs. Potency of cyclophosphamide ranged from 92 to 107% with all samples +/-10% of labelled strength at all time points. DISCUSSION/CONCLUSION These results demonstrate variability of compounded chemotherapy products, and highlight the need to consider both potency and stability when prescribing orally compounded chemotherapy.
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Affiliation(s)
- J H Burton
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, California
| | - H K Knych
- Department of Molecular Biosciences, University of California, Davis, Davis, California
| | - S D Stanley
- Department of Molecular Biosciences, University of California, Davis, Davis, California
| | - R B Rebhun
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, California
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