Leukeran?

Hi, our kitty had an U/S last week and has thickening of the small intestine, plus pancreatic changes suggestive of pancreatitis.

She is not really responding well to prednosine now (though she has responded well in the past). She is also on cypro and flagyl.

Next step according to our vet is to consider leukeran.

Does anyone know how bad any leukeran side effects may be? Does anyone here have any experience with this drug?

I am a little nervous about starting her on this, but she is not eating at all well at the moment so I think we will have to.

Thanks.

Melaniewa said:

 
Hi, our kitty had an U/S last week and has thickening of the small intestine, plus pancreatic changes suggestive of pancreatitis.

She is not really responding well to prednosine now (though she has responded well in the past). She is also on cypro and flagyl.

Next step according to our vet is to consider leukeran.

Does anyone know how bad any leukeran side effects may be? Does anyone here have any experience with this drug?

I am a little nervous about starting her on this, but she is not eating at all well at the moment so I think we will have to.

Thanks.

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My cat had severe IBD, pancreatitis that responded well for many months with prednisilone and other supportive treatments until it stopped working and we moved to Leukeran.  My vet explained that 80% of cats tolerate it.  If your cat doesn't tolerate it (nausea, etc) then you take him off it and offer palliative care and supportive care for as long as is reasonable.  No one will suggest you keep a cat on leukeran if they dont tolerate it.

I would discuss with your vet adding Cerenia, which is an amazing anti-nausea drug to the routine, it may help him eat now, and may help with side effects later.

A great intervention with IBD, pancreatic cats who are having trouble eating is what my vets call the kitty cocktail, Sub Q fluids with injectable cerenia, zofran (another anti-nausea), Pepcid, and B12.  I might consider doing the above to see if you can jump start her appetite before starting the leukeran, if the above helped, you'd know right away.

Leukeran is used when Pred stops working, usually when you suspect the IBD has changed into small cell lymphoma, but right now this is guesswork as you don't have a biopsy result.  Pancreatitis can depress appetite very easily, and relieving those symptoms might go a long way to helping the appetite, but Leukeran is a valid strategy when indicated.  Discuss all this with your vet.  

Wishing you the best, I've been there, tough times.

I have a Calico cat sitting on my lap right now on Lukeran.  She has IBD and also a bladder tumor.  She tolerates Lukeran very well because I offset any potential nausea with Cerenia which I give the evening prior to the Lukeran.  Lukeran is compounded by a pet pharmacy into a prescribed dosage.  Hers is 2.2 mg in a small #4 capsule.  I also give 1/4 of a Mirtazapine if needed every 5 days if the appetite wanes.  I would not at all be afraid of starting Lukeran.  I also echo everything that StephenQ writes.

You definitely want to keep your cat eating and keep inflammation down, especially if Pancreatitis is looming.  I lost two beloved cats to this despite 24hr intensive care at a top Veterinary hospital under the care of an Internal Medicine specialist and thousands of dollars later.  Do everything you possibly can to keep your cat eating and the inflammation well under control.  Lukeran can definitely help.

My heart goes out to you having been down this very difficult road.

Thank you both so much for your replies. Yes, looks like the next step will be leukeran.

She is on zofran, cerenia, cypro and pred at the moment plus subq fluids every other day and B12 shot every week, but she is till barely eating unfortunately.

Melaniewa said:

 
Thank you both so much for your replies. Yes, looks like the next step will be leukeran.

She is on zofran, cerenia, cypro and pred at the moment plus subq fluids every other day and B12 shot every week, but she is till barely eating unfortunately.

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Wow she's on all the good stuff so its worrisome she isn't responding.  I hope the Leukeran helps.  Let us know.

I agree with StephenQ that your cat is on all the good stuff, but I strongly suspect that pancreatitis is the main reason for the lack of appetite.  You said that the Ultrasound showed pancreatic changes suggestive of pancreatitis.  It has been my experience that Ultrasounds never show pancreatitis as bad as it really is.  I recommend you request the Idexx Snap Feline Pancreatic Lipase test.  This is done at Vet's office with a bit of blood and takes only 10 minutes to show.  Cost should be less than $50.  I must caution you however, that this test is often deceptive.  It can give a "false negative" unless the pancreatitis is really bad.  The better test is the  Spec fPL test which must be sent out to a lab and takes a couple days to get back.

With pancreatitis, cats do not eat, or eat very little and run the real risk of developing hepatic lipidosis (fatty liver) if not provided enough calories. This complicates recovery greatly.  Once pancreatitis sets in, it is like a wildfire.  Intravenous fluid therapy, pain management, anti-nausea therapy and nutritional support is key. 

Lukeran will not help unless you get the pancreatitis under control.  The sooner the better.

Melaniewa said:

 
Thank you both so much for your replies. Yes, looks like the next step will be leukeran.

She is on zofran, cerenia, cypro and pred at the moment plus subq fluids every other day and B12 shot every week, but she is till barely eating unfortunately.

Click to expand...

I agree with @babiesmom that it could be pancreatitis, and as she said the PLi test for pancreatitis is more accurate if the cat is actively having a flare up, which it sounds like your cat is having.  Ruling in or out Pancreatitis would be very helpful.

Interesting. So if the test came back positive for pancreatitis, is there more that I can do for her that I am not doing now? 

Or is it more that it would show that leukeran would not help?

If the test is positive for Pancreatitis, cat will likely need to be hospitalized with supportive care.  Your Vet will advise.  This will include IV fluids, pain management and nutritional support.  The goal is to ensure that the pancreas is being adequately perfused with fluids to decrease inflammation.  With decreased inflammation and pain, the cat may begin to eat more on its own.  They may try syringe feeding the cat   Sometimes, an esophageal feeding may need to be placed (at least temporarily) until the cat improves and starts eating again. There is no "quick fix" for this serious disease, but the sooner it is diagnosed and treatment begun, the  better the outcome.

I would request the Spec fPL to either rule Pancreatitis in, or rule it out. 

I asked our vet about this test. Her reply was that the U/S would be more accurate than the blood test so it does not sound like she wants to pursue the blood test.

If I understood correctly, she said the treatment plan would be the same.

We first try and get her to respond to anti nausea meds, pred and fluids. And if her eating does not improve, then try the leukeran.

The U/S said her pancreas was moderately  and generally hypoechoic and thickened (8 - 10mm) and her small intestine mildly thickened  (up to 3.3mm). Also the spleen was moderately and generally thickened (14.5 mm)

That sounds like a different approach from what you suggest, so now I don't know what to do!

My plan for the moment is just to stick with anti nausea meds, pred and fluids. She did eat better last night and this morning

Based on the description of the Pancreas from the Ultrasound report, I think we can all agree your cat has pancreatic changes consistent with pancreatitis.

Pancreatitis is very painful for cats and this leads to them not eating.  Has your Vet offered any pain medication?  This is usually an integral part of treatment. 

It is good your cat ate better last night and this morning.  Hopefully the anti-nausea meds, pred and fluids will increase the appetite even more.  If at any point she does not eat and you cannot readily restart eating, consider it a crisis.  Cat needs to be hospitalized on IV fluids and supportive care.

It has been my observation that cats suffering from pancreatitis are very lethargic, don't move about much.  Also they seek warmth--laying over heating grates or near heaters.  This is because their temperature drops.  Then they get further dehydrated and sicker.  Watch for any diarrhea.

Pancreatitis and IBD go hand in hand as organs are so closely located.  Follow your Vet's advice and be vigilant.  Monitor your cat very closely. 

Thanks again for the feedback, much appreciated.

I have a call into my vets office now about the pain meds, so I will have to see what they say.

I have been doing subq fluids every other day. I have also asked the vet if I should be doing subq fluids every day or not. Generally she seems to eat better on the days that she has subq fluids.

Your kitty thanks you for being such a proactive pet parent.  It's not easy sometimes.  Been there, done that.

Ha, ha - thank you!

I just hope I am not driving my vet crazy with all of my questions