Anemia from long term use of leukeran

Hi - I am wondering if anyone has had experience with non-regenerative anemia caused by long term use of leukeran?  My 18 year old kitty, Griffin, was just diagnosed with pretty severe anemia (RBC of 18.5) that appears to have been developing slowly over time.  Since he was first put on leukeran, his RBC has been in the low 30 range.  His internist first noticed slight anemia (RBC 27) almost eleven months ago.  At his recheck in late November, his RBC had dropped to 23.  Because he was progressing slowly, his doctor recommended a recheck in two months.  Last week, he came back with the RBC of 18.5, which much lower than expected, especially since he has not yet started showing clinical signs other than napping a bit more.  Given his age, he sleeps a lot as it is.  He is otherwise perky and sociable and though he sometimes wobbles from muscle wasting due to long, long term pred use, he isn't showing any weakness. He is being treated with a ton of meds for end stage cardiomyopathy and advanced IBD.  He was put on leukeran more than 4 years ago and has been taking it continuously ever since, although his dosage has dramatically reduced over time.  During the past year, he has been on 2mg every 10-12 days.  His doctor suspects the leukeran, although he also has fairly well controlled CRF that could also be the culprit, but his doctor thinks the leukeran is more likely given the long term slow progression.  His doctor took him off the leukeran and he had his last dose 2 weeks ago.  The plan is to check his hematocrit at two weeks and see where things are.  If he shows clinical signs, a transfusion is recommended, and while I am resigned to this, I am terrified to go down that road.  The hope is that with removal of leukeran, his RBC will bounce back up.  His regular vet thinks we could see improvement at the two week mark, but his internist thinks it will take a month.  I am really worried for him and can't help worrying that his end may be near, but both doctors think he has a fair chance of bouncing back.  Has anyone had experience with this and if so, how long did it take to see improvement after the leukeran was stopped.  Thanks much, Griffin's mom.  

So he has IBD, cardiomyopathy, AND CRF, plus he's 18 years old.  Wow, he's one tough kitty .

I have no experience with leukeran OR anemia, but I know there members here who have experiences with either one or possibly both issues.

I sure hope his numbers start going back up .  If not, isn't there something else they can give him other than a transfusion?

Mrsgreenjeens - thank you so much for your kind thoughts and for asking.  And yes, he is a tough one.  His biological sister has just as many medical issues and I almost lost her last January from a different medical issue.  Luckily, she is still with me, fat and happy.   Griffin's IBD was considered advanced 7 years ago.  He has had cardiomyopathy for 6 years, and while he was stable for a long time, he entered "end stage" in March.  Though his internist thought it could be a matter of days or months before he went into actual heart failure, he has defied the odds.  In fact, his echocardiogram results in November showed no worsening of the heart thickening and an actual improvement of cardiac function.  The little guy has continued to amaze me at every turn.  

You asked if there is anything they can do other than a transfusion.  Unfortunately, not at this time.  Because his doctors think the long term leukeran use may be to blame, we need to make sure it is out of his system, which may take a month, before we can definitively say that it was not the cause of the anemia and move to another treatment option.  As I understand it, if he shows improvement, it should start some time between late next week and a month from now, but it would be expected to be slow improvement.  In the interim, his RBC numbers are so bad that he is likely to start showing clinical symptoms and something has to be done at that point as his life is at risk.  I am told that a transfusion would buy us three weeks to a month to get us to the time when his bone marrow should start improving if the leukeran is the cause. 

If after a month he shows no improvement or worsening anemia, then the anemia is probably a result of his CRF.  I have been told that there is only one option at that point and it is not a sure bet.  His internist recommends we try darbepoetin alfa (Aranesp) shots, which seem to have fewer problems than epogen shots.  Unfortunately, Griffin's internist is a 45 minute drive away and he hates, hates, hates the car.  The Aranesp shots should be given multiple times a week at first and I am worried that all of the stress from repeated travel could result in a cardiac event.  His regular vet, who is much closer, has never used Aranesp because of the potential side effects and said she is uncomfortable doing so.  She hasn't said she won't, but I would not be surprised if she did.  If we get to that point, I may have to try to find another local vet in the area who will give him the meds.

His long term outlook is so much better if the anemia was caused by the chemo.  I am trying to not get overwhelmed and stay positive, but not get my hopes up too much and ready myself for the worse all at the same time.  That can be a difficult task in my house, as Griffin is only one of three sick "kids" and I am currently administering 22 doses of meds each day between the group. 

Whoa!  That's a lot to handle Don't know if you're already aware of this site or not, but here's a little info about CRF and Anemia that you might or might not find useful:  http://www.felinecrf.org/anaemia.htm

My Sven died last year of CRF and I referred to that site religiously for various things.  Many people on this site use that site for reference .  They also discuss Cardiomyopathy and other related diseases...just click on the "related diseases" tab towards to top when you get to that website. 

for you and your furkids.  Keep us posted as to how they are doing, especially if Griffin's numbers improve now that he's off the leukeran

Quick update on Griffin's anemia.  Griffin had to spend some quality time at the emergency hospital today because he was sleeping a lot, was lethargic when awake, constipated (with blood in stool), only wanted to nibble his food, and otherwise wasn't acting like his usual self.  I was sure his red cell count had tanked over the last two weeks, so that was the first thing they checked.  Surprisingly, his packed cell count was up to 24 (from 18.5).  Renal tests looked good too.  The only thing out of the ordinary was that his potassium was slightly low.  We are thinking that the GI symptoms are likely the result of being taken off the leukeran, which has controlled his IBD for years.  Griffin got a B-12 shot and came home.  He has been home 4 hours now and has been significantly more perky and interactive than he has been for the last 3 days.   I know that his red blood cell gain is fairly minor, but it is definitely heading in the right direction.  If the leukeran was the cause, we should see continued improvement the longer he stays off the drug (of course, the down side is a possible return of all of his IBD symptoms).   

Well, good news then, huh?  But what about the low potassium...did they not treat that, or did they think the B-12 shot would help that?  I figured they might give him some actual potassium supplements. 

that his IBD doesn't return, or get any worse.

They have started him on a potassium supplement, but they are starting him on a low dose, as one of his heart meds can actually cause high potassium.  We will recheck his potassium in two weeks when we recheck his red cell count and will adjust as necessary.   He is already showing a return of some IBD symptoms (occasional vomiting in the morning before eating and a small amount of blood in stool) but I think I am more bothered by them than he seems to be at this point.  He has been feeling really good today and for now that is all that matters!  

Here is a final update for this thread.  Griffin's anemia rebounded at about 1.5 months after stopping the leukeran and all seemed to be going great.  However, he started having increasing bowel issues - which was the purpose of the leukeran to begin with.  Other than the bowel problems though, he felt wonderful!!  On 3/26 he had his bowel scoped to see what was going on and the doctor discovered an advanced tumor that she couldn't resect.  My guess is that the leukeran had been slowing its progression and when we took him off the leukeran for the anemia, the tumor grew out of control.  Unfortunately, there was nothing we could do, so my darling crossed the Rainbow Bridge that evening. 

I'm so sorry. :heart3: You and Griffin fought the good fight, and he sure was one heck of a kitty!

I'm so sorry for you loss. when you feel up to it please consider starting a tribute thread in the Crossing the Bridge part of our forum. May Griffin rest in peace.