Chlorambucil treatment for Small Cell Lymphoma- Mouth Clawing, tongue tearing

Hi, I'm wondering if anyone else has ever had this reaction to Chlorambucil. My best friend, Catnip, was recently diagnosed with Small Cell Lymphoma in his intestinal tract. I gave my first dose of Chlorambucil 2 days ago. At 6:00 am I dosed Catnip, by 3:00 pm he was violently clawing at his mouth and gagging. I initially thought he was choking on something and raced him to my vet. At the vet he of course was scared and didn't claw at his mouth. The vet told me to call my cancer specialist if he started doing this again. As soon as I got home he began again and he looked like he was trying to pull his tongue out. He bloodied his paws as I was trying to reach the specialist. Wrapping his paws and hugging him to me I was able to get him to stop by massaging his neck. The vet tech checked with the temp vet and said they had never heard of this as a side effect of Chlorambucil. They said to stop giving the Chlorambucil till my regular specialist was back on Monday. Also, said if this continued he may be having a strange reaction to the drug like an allergy. They said to try Benadryl. Poor Catnip continued to try to claw out his tongue and I was able to get a Benadryl into him and syringe water to get it down. I had to continue to massage his throat and was able to get him to calm down. It helped to make him sleepy and stop pawing. He was sleepy the next day but is back to normal. I talk to the specialist Monday but I'm afraid they will want me to try it again. I do not plan to put him through this again but was wondering if any one else has ever had this issue?

I have no experience with this at all, but it does sound like his tongue was itchy. I remember years ago I got my last dose of penicillin. It felt like my blood itched. It was maddening. Makes me wonder if his tongue felt similarly itchy.

Thanks for your response, Laura Mae. I too think either his tongue or throat were reacting to the drug. I was thankful that the Benadryl seemed to work well. I too have had a reaction to an antibiotic and had facial itching and throat swelling so I know how you felt! Was just curious if others had experienced this reaction. It was such a horrible thing to see him do I hope to never have him go through this again! I had such high hopes for the chemo treatment as I was told cats don't usually feel bad like people do. He doesn't deserve to be scared and go through this, however. I plan to make the rest of his life as comfortable and spoil him as I always have but I think I might have been the one wanting to see if I could get a few more years with him. I plan to do the best that I can for him but listen to what he needs not what I want,  Thanks again for your response!

dedem10 said:

 
Thanks for your response, Laura Mae. I too think either his tongue or throat were reacting to the drug. I was thankful that the Benadryl seemed to work well. I too have had a reaction to an antibiotic and had facial itching and throat swelling so I know how you felt! Was just curious if others had experienced this reaction. It was such a horrible thing to see him do I hope to never have him go through this again! I had such high hopes for the chemo treatment as I was told cats don't usually feel bad like people do. He doesn't deserve to be scared and go through this, however. I plan to make the rest of his life as comfortable and spoil him as I always have but I think I might have been the one wanting to see if I could get a few more years with him. I plan to do the best that I can for him but listen to what he needs not what I want,

 Thanks again for your response!

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Well I may be facing the very same diagnosis for my girl Krissy.

She is going to the vet tmrw, has been diagnosed with IBD 2 years agop and is well managed and stable, but something is wrong, and she is losing weight and her appetite has gone way down.

I suspect lymphoma and know chlorambucil is the treatment, so this scares me!

I wonder if it is possible that the pill may not have gone down soon enough and started to dissolve? Do you think there is any chance of that?

Otherwise there may be an injectable form of the med.

What is the treatment plan? I know it varies, 4 days of chlor, 3 weeks off, then repeated like that, or one vet does 60 days straight of daily chlor, which to me sounds like overkill and very hard on the cat......or 1 pill, then 2 wks later 1 pill, and ongoing that way.

Just wondering how often he needs this pill.

I don't have experience with this medication but did this med go inside a gelcap?

That must have been very scary for you to deal with! How is your baby doing?

I just spoke with the Specialist this evening and she said she has never heard of this happening with  Chlorambucil. She feels it could possibly be some strange delayed allergic reaction. She said she has heard this happening with a thyroid med but states she doesn't feel the lab would have mixed this up. Believe it or not if I had another cat and this was a suggested treatment I would try it again. It is supposed to be a very good treatment and most cats don't have any issues. I just won't try it again on Catnip and the vet didn't feel it was safe after his reaction. I will try the Prednisone as suggested and see how he does with the Prednisone and Diabetes. Good luck with your kitty!

BTW I didn't see your other questions at the end of your note till now. I do feel the pill went down all the way as it was given at 6:00 am and he began doing this at 3:00 pm. It was a hard pill not a gelcap.

The recommended dosage I was going to be giving my cat the Chlorambucil was every other day. The specialist did say there were other dosage regimes but this was the route she took and then as the cat responded she would decrease as needed or depending on the tolerance.

I have a 6yr. neutered tabby who was also diagnosed with IBD and Small Cell Lymphoma of the small intestine. We have been giving him the same chemo and steroids which he is responding to very well. His numbers have been good so far. No side effects. The chemo is in a liquid form and the steroids are cream form I put on the inside of his ear. What form is the chemo in? A pill might have been stuck in his mouth? I hope he's feeling better. I know how a diagnosis of cancer feels. I wish I could explain to my kitty why I have to give him meds. It's not fair.

katiekat 143 said:

I have a 6yr. neutered tabby who was also diagnosed with IBD and Small Cell Lymphoma of the small intestine. We have been giving him the same chemo and steroids which he is responding to very well. His numbers have been good so far. No side effects. The chemo is in a liquid form and the steroids are cream form I put on the inside of his ear. What form is the chemo in? A pill might have been stuck in his mouth? I hope he's feeling better. I know how a diagnosis of cancer feels. I wish I could explain to my kitty why I have to give him meds. It's not fair.

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I am so glad that your kitty is doing well on the meds for IBD and the lymphoma. It is so very hard I agree when you are trying to do the right thing for your pet and they can't understand why you are doing this to them! I am going to start the Prednisone at the end of the week and will see how he responses and if it interferes much with his diabetes. My kitty is finally starting to respond a little better after last Friday. My fingers are crossed. Keep us posted how your precious one is doing!

Thanks! I will update soon. Keep us posted too. [emoji]128570[/emoji]

Wow, that is so scary!!! I hope your little buddy is feeling better. My cat started Chlorambucil about two weeks ago and aside from general malaise and tiredness he's taking it quite well. I would definitely be curious to see what the vet says. I've never heard of this before and I've read just about every article there is on Chlorambucil and Small Cell Lymphoma...

Good luck! I'm sure the specialist will find another solution...

I too have a cat on Chlorambucil.  She gets 2.2 mg compounded in small #4 capsules.  I give it three days a week.  This reaction sounds like it did not all go down or some of it got on her tongue.  I give it using a "pill gun".  I shoot it at the back of her throat.  Then blow on her nose.  This causes her to swallow.  Then I follow with a syringe of water a couple of times making sure all has cleared the mouth and throat.

This has worked very well.

Hi all, not sure if you'll read this since it's an old post, and I'm looking around, but I've been treating my car with pred only. We weren't sure if it was IBD only or small cell, and I wasn't willing to subject her to any more horror at the time since she was about to give up!
But 4 months later she's two pound heavier and ....her. But the vet wanted to start leukeran.
I had it made to liquid. NOPE!!!
IGave her the first capsule Thursday, and on Saturday she was depressed, lethargic and not eating. I gave her cerenia and coaxed her, and finally today (Monday) got her to eat some. Is this normal? Does it get better? That would be an awful quality of life.

Hi,
I'm not sure why your vet is pr scribing chlorambucil without a certain diagnosis of small cell Lymphoma. The only way you get a certain diagnosis is by biopsy thru upper endoscopy or surgery. Most prefer upper endoscopy because less invasive. I wouldn't give your cat chlorambucil unless you know for sure...if your cat is gaining weight and symptoms are gone, stay with the Pred only. Chlorambucil can be rough. Also, pulsed dosing is the best way and least hard on both feline and human. It's administered once every two weeks. A lot of vets don't know what they're doing with this disease unfortunately. Feel free to contact me if you'd like to talk further. Oh! One more thing: ondansetron is better to control nausea. Cerenia is better at stopping vomiting. My cat gets ondansetron 3 x a day on his chlorambucil day and for 2 days after. Cerenia did not help.

I can answer the tx thing! Chlorambucil is sometimes given for agressive IBD as well, and since small cell is diffuse, they sometimes miss the diagnosis with biopsy. Since the treatments aren't very different, and IBD tends to be a precursor to small cell, I opted not to do this. I was crying with her at home before "our final" trip to the vet, where we had an ultrasound (thickened intestinal walls) and a crap load of drugs. Complicate the story? It's presenting as cholangiohepatitis. The only relevance to the story is that her liver has been leading our story. Her symptoms are MUCH better on pred (actigal and her thyroid meds), but her enzymes and bilirubin aren't improving substantially. Sorry for the lengthy explanation.
So, the vet's thoughts- cats do well on Leukeran. She would be getting it every other day, very low dose which is why I'm surprised about the reaction. Since it wasn't within 1-6 hours of taking it, I don't thing the actual drug in stomach made her sick....I'm afraid the action of the drug did. I hate to see her depressed when she had been happy. And honestly, I have PTSD from trying to keep her alive when she wouldn't eat during the worst of her liver/IBD/cholangeohep issues. I stayed with her day and night for a month trying to get her to thrive before we figured out her issue. So bad effects are normal? Like does your kitty just get nausea or There also lethargic/apathetic sometimes?
Thanks for the advice on the nausea meds!! I didn't think cerenia did a whole lot. She didn't throw up...but she wasn't vomiting before I gave it to her!
Do you give any Pepcid or anything?

Hi Katie,
I wouldn't do anything that makes your cat depressed. My cat Abe is definitely more lethargic on his chlorambucil days but that's only every two weeks. I don't believe any cat should be on it every other day or every three days. Too much new evidence now to support an every two weeks protocol.
Email me here and I'll send you some important info:
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first cats wont eat when dehydrated. with chemo- the preferred methods are:
Cerenia/Zofran, sub fluids, stinky wet foods, Pepcid AC and pred. I would ask the vet to allow sub fluids. you can do these at home. The fluids and anti-nausea are given the day before chemo day of chemo AND 2 days AFTER chemo.

Try this and see if it helps.
And of course stick with the pred and other meds.