Need to Start Leukeran/Prenisone Treatment

Hi all,

I read a bit about this here and kudos to all of you for what you've done for your cats! My Zoe has small cell Lymphoma and so they want me to get her started on Prednisone (daily) and Leukeran (2mg every other day). What I read about Leukeran really scares me, it almost sounds like poison. The idea is to get her a 3-4 day head start on Prednisone which is about where I am today.

I guess I am   wondering if the Leukeran is worth the risk.

Any feedback is appreciated.

Dave

Hi @dhoffman. I'm so sorry that Zoe has SCL.     Was it confirmed via biopsy?

It's my understanding that Leukeran is the only treatment to try to combat SCL and put the cat into remission. From what I've read of others' experiences, most cats tolerate it well. There is a minority that do not tolerate it, at which point it can be stopped.

Hopefully someone with more experience on the topic, like @StephenQ, can chime in here.

dhoffman said:

Dave

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Hi Dave

I'm so sorry!  Can you just fill us in a bit?  How did you get this diagnosis?  Was your cat diagnosed with IBD prior?  How old is your cat and what are the symptoms?  A definitive diagnosis of SCL is usually done by surgical biopsy or endoscopy, or sometimes made presumptively based on symptoms and a prior failure to respond to prednisolone therapy that previously worked for a period of time.

Most patients start with IBD, that is controlled up to a point with various combinations of diet, supplements, and certain mild drugs like tylosin, and if/ when that fails to control it, the owner can either biopsy and treat accordingly, or start prednisolone (without biopsy) which will usually control it for a decent amount of time, and only when that fails does one move on to the leukeran.  Although i have heard of some vets who like to start Pred and Leukeran at the same time, our oncologist said that pretty much no matter what you do, most cats have 1-2 years with SCL if you try all available therapies even if one at a time.

Having said the above, when the time came for my IBD cat to begin leukeran (after 15 months of controlling it through the Pred) both my primary vet and our vet internal medicine specialist said that 80% of cats do basically fine on leukeran with little to no significant side effects, and that 20% react badly and get very bad diarrhea, loss of appetite, and that if that happened you'd know it quickly and you would stop leukeran therapy.

So it isn't just "leukeran is poison" and i have to put my cat through that: its more like if my cat tolerates it then good and you continue, and if my cat reacts badly you stop therapy and look at alternatives.  For those of us who start with the Pred, if the cat starts gaining weight then our cat is winning (against whatever it is, IBD or SCL) but if the cat fails to gain weight, or starts loosing it after gaining, then we're loosing the battle and we must look at other therapies or start giving up.

We opted to do a surgical biopsy prior to starting pred therapy and it was negative for SCL so we started pred.  That worked for 15 months and then it stopped working.  Note that SCL is usually considered part of a continuum with IBD.  IBD (inflamed cells in the intestine morph and mutate into cells that are cancerous - not a mass like a tumor, but changes to the cellular structure that is considered cancerous and that destroys the ability of the intestines to function.  Cat gaining weight = remission, cat loosing weight = disease in progress.

Once Leukeran became the only option for our cat we put him on it and he reacted badly so we stopped therapy in less than a week, and moved on to a stronger steroid, and went from there.  Eventually through a needle aspirate of the lymph nodes we got a different diagnosis, a much rarer cancer, and treated him with a different drug that he tolerated well enough to allow continued therapy.

Thanks Steven, et al! My cat is 10 years old, she's had IBD most of her life despite diet changes, Diagnosis was confirmed by x-rays and mostly ultrasound including thickening of the intestinal walls. Also our prednisone regime did not stop her from continued weight loss, she's down about 2.5 pounds in

about 2 months. She's currently not doing any vomiting but I fear that will change with Leukeran although your numbers are reassuring and that is the vets hope as well. She has relegated herself to one room of the house on the ground floor mostly I think because she just doesn't feel good, not necessarily that she is in pain.

Appreciate the responses immensely!

Meant to say thanks StephenQ, no edit function I guess, apologies!

dhoffman said:

 
Meant to say thanks StephenQ, no edit function I guess, apologies!

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No apologies needed, and thanks for all the info, your cat is presenting with the classic IBD to SCL scenario.  I think what confused me a bit in your first post was the idea that your cat hadn't been on pred yet, and that you were starting pred and Leukeran at the same time, but now is sounds like she has been on pred,  and its not or no longer working as her weight is down and that Leukeran is the next step in a series of many steps you have taken.

No one knows your cat better than you and your vet, but it sounds to me like its basically time to try leukeran and hope for some remission, or prepare to say goodbye.  Sometimes dexamethasone (a stronger steroid) works when Pred doesn't, but i think the general route is try the leukeran first, and if that isn't tolerated or doesn't work, you try some Dex as a hail mary pass.  If the leukeran works for a period of time and then it fails, then you can either choose to let your girl go, or consider one of the really more intense drugs, but that you can freely and fairly choose not to do.

Leukeran is a reasonable "play" - if she tolerates it she may gain real time and real quality of life, if she doesn't tolerate it you will know probably by the 2nd or 3d dose at a maximum, and then you stop giving it to her, and start making her comfort be a priority along with any other last options you may be able to try.

I know what you and your cat are going through.  I've been through it.  You've been making good and difficult decisions.  Remember this:  Our animals don't think about tomorrow, they only experience today.  You however can project into the future and so long as you think her future has options, you can expose her to a limited amount of discomfort to get her through to a better place, but when you think those options are no longer reasonable for her - something only you can know, then its time for you to make the hardest decision of all, and she will be grateful for it.  Tough times.

On a lighter note, there is an edit button, its at the bottom of your post on the left, its a pencil icon. Click it.  I think however that newbies are given a very short edit window, and the more posts you make the longer your edit window remains open, one of the perks for hanging around here.  Maybe newbies can't edit at all, not actually sure!