Decreased Appetite on Chlorambucil

For those give or have given this Chlorambucil to their cat, does the decreased appetite experienced by the cat eventually come back around.

In other words, will the cat's system get more "accustomed" to the drug in time?

I've started my cat on this drug for IBD/lymphoma and it has been a real chore to get her to eat, which is essential now that she is also taking insulin for steroid-induced diabetes.

I know there are some who are really against the use of this drug because they say it brought great harm to their cat, I understand that and am paying very close attention to Vivian's how Vivian reacts to it. There are definitely changes in eating, pooping, energy, attitude -

I'm looking for some evidence that these things will turn around in time.

Experiences?

thanks

How is Vivian today?

I don't have any experience using Chlorambucil, but I remember reading from other people's experiences that some cats do well with it and some don't. Perhaps this is Vivian not handling it well. I'm not sure.     But I'm going to mention @StephenQ and @LDG to see if they have anything to offer.

Vivian is hanging in there today, she greeted me when I got up and is sitting with me and purring now. Seems like small stuff but considering behavior changes in the last week it's a pretty big deal.  Poop looks good this a.m. but still struggling to get her to eat, with insulin time approaching. She got a little chlorambucil reprieve last night b/c I couldn't find her when I got home from my work event. Vet had said 60 hours as opposed to 48 between pills ( her schedule is M-W-F) might help, so I wasn't too concerned about it.  Between the chlorambucil side effects and all the fuss about getting her to eat enough before insulin, she is more wary of her people and hiding/running away, which never was the case unless the cat carrier came out. She is sleeping a bunch more too. Today I am teaching myself to do a blood glucose test and will try to do a BG curve on Vivian tomorrow. I anticipate that a complete amateur sticking her in the ear every two hours will send her running. On a positive note her drinking and urine output went down almost immediately after she began a very small dose .5U of lantus insulin a week ago. My greatest concern is tapering pred beginning this week, which is the thing that gave her an appetite (and diabetes) and continuing chlorambucil, which significantly decreases appetite, to address intestinal inflammation. She has lost a lot of weight in the last year because of intestinal disease but was maintaining between Feb and May on the pred. She can't afford to lose much more. Fingers crossed her system will adjust to chlorambucil (does this happen?), pred can be tapered to the extent her BG returns to normal and insulin can be discontinued, the sooner the better. 

Thanks for asking

Cat Pal said:

 

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Hi @Cat Pal

First before i ask you a few questions i want to put this out there: while we deal with serious issues here, and sometimes less serious ones, make no mistake, this is a serious one.  Big Medicine, and regardless of what you read here, your first resource should be either your primary vet, internal medicine vet or oncologist or a combination of the above.

- Was her appetite ok or better before starting the Chlorambucil (Leukeran)?

- Is she, or has she been on prednisolone, and if yes, is it no longer working, ie she is losing weight?

- Did you receive a diagnosis of lymphoma by biopsy or endoscopy?  Or is a presumed diagnosis due to due to a combination of symptoms and their failure to be controlled by a more conservative therapy like Prednisolone?  Or is it not clear, and your vet said you are either dealing with an advanced and serious case of IBD or  lymphoma?

In any case, my cat's IBD stopped responding to pred after about  15 months and we started Leukeran (Chlorambucil).  He did not tolerate it well, and had severe (or at least very significant) diarrhea, and our vet advised us to stop giving it as she said the diarrhea wouldn't resolve on its own.  Both she and our internal medicine vet said that cats have an 80% chance of tolerating leukeran well, but 20% don't and they should stop the treatment.

The question in my mind is, is your cat's reaction manageable?  Can you get enough food in her?  Have you tried yummier foods?  Does her appetite improve between treatments?

The bottom line is, we can ask you questions to ponder, and we can give you our personal experiences, but again, this is Big Medicine, and my biggest advice is to be in close touch with your vet on all these issues.  By the time my cat's illness got to the point of Leukeran therapy (and others that followed) I was talking to my vet by phone somes as much as every other day or daily, and seeing my vet once or twice a week.

Stephen

To answer your questions:

Vivian's appetite was much better before starting chlorambucil, which I think is due in part to the 5 mg daily prednisolone she began taking in late Feb, three + months ago. It did address her symptoms of loose/frequent stool with fresh blood. Bowel movements have become less frequent, usually firmer, but still with a small amount of blood at the very end of at least some of the movements. So pred did and does address her intestinal trouble up to a point, and from there I have seen no further improvement. She had lost a couple of pounds before May last year, which she needed to lose, and then three more pounds between May and Sept., when diagnosed with benign thyroid tumor and hyperthyroidism; she had surgery to remove tumor and 1/2 of thyroid. Weight loss and intestinal distress was attributed to that condition, until it didn't resolve after thyroid function normalized. Sept to Feb she lost another 1/2 pound or so and has maintained that weight since she went on pred. In Jan and Feb she had two ultrasounds, one showed inflammation/thickening and loss of layering at the end of the small intestine and throughout the large, with at least one enlarged lymph node. The other ultrasound showed no enlarged node but severe thickening of the large intestine/colon only. Both reports said the findings were consistent with what lymphoma looks like. Before one ultrasound she saw an oncologist, and a needle aspirate biopsy did not confirm lymphoma - so we don't know for sure - we only know it acts like lymphoma, but so does IBD. I won't put her through more intestinal diagnostics at this point. The oncologist suggested starting pred and moving to chlorambucil if it didn't resolve symptoms. The internal med specialist who works at this specialized med hospital is also aware of her case and has been in contact with Vivian's primary vet for consult on elevated BG. It was the specialist who said go w/ chlorambucil and Lantus and move toward tapering pred., fortunately they are amenable to phone consults since I have had two cats in there and spent thoursands of $$ since Feb,  b/c they are 90 minutes away. I am in regular contact with Vivian's primary vet, phone-email-in person, as recently as this morning. Sometimes I am more and sometimes less satisfied with her responses, I feel like she is so busy with all the animals she treats in her one woman show she can barely keep up with it all. But she does consult the specialists, so that's good.

Vivian feels worse the first 24+ hours after chlorambucil and starts to come around after the second day, unfortunately that's about the time she needs to be pilled again. It makes her stool looser for about a day, it has significantly decreased her appetite (unless that's the insulin, they were started the same day per the vet). I think we're finding out if I can get enough food in her, she is eating some but not enough, which is double jeopardy since she's on insulin now. I've tried to make the px food yummier with tuna juice, cheese, pieces of cat treats, with mixed success. I still don't think she eats enough. I've heard folks talk about feeding junky food that tastes good to cats, like fancy feast. So I'm going to try that. We're in a tough spot. She needs something to address ongoing intestinal trouble, but pred had driven up her blood glucose so it may be best to get her off and onto something else - that would be chlorambucil or something I don't yet know about.

One way or another it's about getting her to eat but also ensuring her body can break down and use the food. I am hoping she adjusts to and tolerates chlorambucil in the near future better than she is now. it doesn't make her violently ill, and she needs something for intestine disease, but she can't afford to lose more weight...

thank you

Cat Pal said:

 

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Thanks for the detailed response.  A very complicated case and sounds similar to my cat's condition at the time who also had thickened bowel with loss of layering.  After we took him off Leukeran (chlorambucil) due to his clearly not tolerating it, and two more need aspirates of his lymph nodes, we finally got a diagnosis no of lymphoma but the less common mast cell cancer.  Leukeran does nothing for this so its a good thing that he didn't tolerate it, and he was put on Palladia, the only drug that fights mast cell cancer.  Unfortunately, the diagnosis came too late and while he tolerated the Palladia, it was too late to get him into remission.

You are in a tricky spot as a) you don't have a definitive diagnosis and b) you are also dealing with quality of life issues.  I hope the Leukeran works for her.  I've been there and i don't envy you.  In time there will be more clarity, but at what price to you and to Vivian?  Hopefully she will gain weight on the leukeran, if she does that is obviously a good thing.

Every moment is precious and there is never enough time.  I wish you all the best and keep in touch.

May i ask generally where you are located?

Thanks

Stephen

Stephen

Sounds like you went the route of chemotherapy you can only get at an oncologist's office? Also sounds like you may have lost your cat and if that's the case you have my condolences. The oncologist I visited told me I would need to bring Vivian there - the 90 minute drive - to receive chemotherapy beyond chlorambucil which as you know can be prescribed by a primary vet. Knowing I am not going to drive Vivian that far that frequently for that long I guess makes it unnecessary for me to know if she has another kind of cancer. If it's small cell, I am now treating it. If it's not small cell, I wouldn't be going that route with Vivian anyway.

Of course, I also once said I wouldn't put her through an ultrasound or a single trip to the oncologist or a biopsy. I guess as I've seen Vivian struggling I've made about-faces on former proclamations. I thought I knew the limits on how far I would go, because I know that long car trips and rounds of meds and frequent vet visits would indeed compromise this squirrelly cat's quality of life. All ailments aside, I do feel she still has quality of life and is able to give and receive happiness and comfort. She's not an old cat - 10.5 - and I just keep telling myself we've hit a rough patch but if we can just get her to a place where she's off the pred, which should reduce BG, and on something that manages whatever's going on in her intestines without bringing her more harm we'll be good - the question remains if chlorambucil is that something. Seems all the success stories are remaining hush on this one - that's all I was really looking for.

I live in Vermont -

thanks!

Cat Pal said:

 

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Cat Pal,

my situation was a little different then I believe you expect and i'll try and clear that up.  And yes, my best friend Simon did succumb to his illness, fortunately he went very quickly at the end and we were able to euthanize him in a timely way, and giving him comfort until the end.  He is memorialized here, but don't feel like you have to visit at this delicate time.  http://www.thecatsite.com/t/292577/i-have-lost-my-simon-after-15-years

When the standard oral chemo like Leukeran fails, the next step - should anyone wish to pursue it, and there are good arguments to be made that one might not want to, is weekly IV's etc that require both an oncologist, regular trips and careful monitoring.  Simon never went that route. When the diagnosis changed from a presumptive diagnosis  of small cell lymphoma - which is the common development to severe IBD, to a positive diagnosis of mast cell cancer, he was switched from Leukeran to Palladia, an every other day pill.  Yes it was proscribed by an Oncologist but it was filled by a pharmacy and given by me at home.  So basically he went from one pill to a different pill, but Palladia is not for lymphoma.

Sadly by the time we got the right diagnosis and the right medicine, the illness was too far ahead of him and it won.

It sounds like you are doing all the right things.  Each day you make the best decisions you can with the info at hand and by "talking" to your cat and you go down the path with her, hoping for the best.  There is no cure for lymphoma, so all we can hope for is quality time.  If you want to possibly increase the odds of hearing some success stories, you might want to start a more specific thread and use the more commonly used name of Leukeran, something like this "Looking for sucess stories using Leukeran for small cell lymphoma".

I have friends in Vermont, a great state

Stay in touch

Stephen