? Chlorambucil for lymphoma

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Lisa and Smoky

Lisa and Smoky

Member Since 2016
Smoky was at the vet to get another ultrasound done. He has had drastic weight loss and is not gaining back the weight. The vet thinks he has intestinal lymphoma which started out as IBD. He also has an enlarged kidney. He wants to treat him with chlorambucil and prednisolone. Anyone else have any experience in giving this to their cat?
 
Lisa and Smoky said:
Smoky was at the vet to get another ultrasound done. He has had drastic weight loss and is not gaining back the weight. The vet thinks he has intestinal lymphoma which started out as IBD. He also has an enlarged kidney. He wants to treat him with chlorambucil and prednisolone. Anyone else have any experience in giving this to their cat?
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I am following this too. My vet suggested it as well. My best friends cat has been on it for 3 months. He gained 1 pound and is doing much better. But has gawd aweful dierear and it stinks. Joey is his name. She has Monica, Chandler. And Joey. I have Phoebe :)
 
My previous cat was on both chlorambucil and pred for intestinal lymphoma. She was on it for about 11 months and did pretty well until she developed an intolerance to the chlorambucil and threw it up every time I gave it to her. At that point she declined quickly and the pred alone was not enough. While she did well on it she gained all her weight back, ate really well, and had no diarrhea. She did throw up now and then but not very often. She was also on b-12 injections that helped a lot. Had I caught her condition earlier she may have done better but she was pretty sick by the time they diagnosed it. Very frequent blood tests need to be done to check for other problems the chlorambucil can cause. Some cats do very well on it for several years but my kitty was not so fortunate. It's worth a try to see how well he does and you would most probably know pretty quick if it's helping. Poor Smokey- sending kisses from Leo.
 
Thanks Lillie for your story. I may give it a try although I don't have results back yet from blood work. The vet wants me to start right away but can't get the chlorambucil until Monday. How often do I need to get blood work done? I think my vet said once a month.
 
I think (but not sure) it was once a month in the beginning but later on it was every three months. The pred got her eating right away and she started gaining weight pretty quickly too. I hope Smokey does well on it.
 
An endoscopy or surgical biopsy is the gold standard for diagnosing small cell lymphoma. But you have to do those before starting pred. My civie is on both prednisolone and Leukeran (chlorambucil) and has been over a year. The pred immediately stopped his vomiting. My girl Neko was on budesonide and Leukeran. She had heart issues which precluded pred, and it doesn't impact the blood sugar as much.

There are a couple of protocols for the chlorambucil. The pulsed dosing or dosing every two weeks is usually easier on them than the every other day method.

There is a online groups.io list for Feline smallcell lymphoma that you might want to join.
 
Smoky hasn't had any vomiting so far which is odd for his diagnosis. Does the chlorambucil make them feel sick? I've heard it was a chemotherapy drug. I will definitely look into the groups for support.
 
I was told that most cats tolerate it pretty well but my cat was not so fortunate. She was ok with it at first but after about 11 months of being on it she started to get sick from it.
 
My two cats had different reactions to chlorambucil. Neko got quite a bit of nausea from it, but that is why the every two week dose helped. She would feel off for about four days, then she would be Ok for 10'days. My other kitty is mostly a bit quiet for just one day after . You definitely want to have some anti nausea meds around, such as ondansetron and/or cerenia.
 
For my kitty it was to be permanent but there may be other cases that are different as to the reason they are on it to begin with. My kitty did go to remission on this, but it was a temporary remission.
 
I tried the every other day method on Jones and it was too hard on him - he slept every second day and felt like crap - no way to live. Vet suggested once a week but as Wendy pointed out to me that wasn't a recognized protocol. With Jones, lymphoma was never confirmed and will most likely not be with a endoscopy which is the only real way to confirm. That said with the pred - his IBD seems better to the vet upon palpitation of the belly though it is still "spongy" as she calls it. I still have the Leukeran on hand and have considered doing the pulse dose method and I will be discussing with the replacement vet. To see what she thinks. It will require regular blood work though to ensure his bone marrow does not become too compromised.

The other issue I had is that the Leukeran is eliminated through the urine, at the clinic was insistent that he be kept by himself and have his own litterbox. That is not a good thing to do to a social cat - it stressed him right out.
 
I had forgotten about that. I do remember now that the specialist asked me if I had any other cats using the same litter box. Fortunately I didn't so it was ok but I was very careful about cleaning it out and used gloves. It's also one of the reasons I had the chloram. compounded to a liquid so I did not have to handle the tablet. If I remember right my kitty was on it every other week for two days. I did not administer it every other day-.
 
We have three cats in the house now. I could not lock Smoky in a room by himself, he wld be miserable. I have an appt with his old vet that he's been going to for years on Monday to go over treatment options and possible euthanasia shld it come to that.

The staff at cat clinic were giving me a hard time about sending results for ultrasound to his old vet. I don't really like it there as the staff are not friendly at all. They are too business like and almost indifferent.
 
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Lillie said:
It's also one of the reasons I had the chloram. compounded to a liquid so I did not have to handle the tablet.
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Mario used the pills (that was years ago when they were reasonably priced). I used a pill gun to administer the pill to avoid touching it. I consider using a liquid more dangerous since with my experience is that some liquid meds seem to get out of a cat's mouth
 
We all know our cats better than anyone else and we all have a sense of what would make them miserable etc. It's a hard decision to make but I know when I looked at my previous cat near the end I just knew she had had enough. It was heart breaking but I knew I was making the right decision for her. I know you will make the right decision for your Smokey whether it be medication or the 'other'. Sending you my most sincere wishes for healing - both for you and Smokey.
 
Lillie is right. We each know our own kitties. Best of luck in finding the path you need Lisa that works the best for you and Smokey.
 
Chlorambucil as liquid is not recommended. The shelf life isn't as long and much easier for you to be exposed to it. i used gloves to stuff it in a pill pocket. My Theo will be on it for life, unless it stops working. Some vet's may lower the dose a bit once remission is reached. Remission can last several years.
 
I had the chlorambucil delivered every month from the compounding pharmacy. The liquid was the only way I could get it in my kitty, as she was impossible to pill orally.
 
Update on Smoky: I'm a bit hesitant to try medications first. I can't know for sure if it's lymphoma without a biopsy being done. I don't want him to suffer though.
I have an appt with my old vet on Mon to talk about the option of euthanasia. They require pre counseling before performing one. His current vet prescribed B12 injections for me to give once a week. She said his potassium is low so gave me Renakare tablets. A course of antibiotics: Enrofloxacin for that; Prednisolone in place of the Budesonide, and bupe for pain. She had to call in a prescription for the Lukeran so can't get that until Monday.
 
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Lisa and Smoky said:
Update on Smoky: I'm a bit hesitant to try medications first. I can't know for sure if it's lymphoma without a biopsy being done. I don't want him to suffer though.
I have an appt with my old vet on Mon to talk about the option of euthanasia. They require pre counseling before performing one. His current vet prescribed B12 injections for me to give once a week. She said his potassium is low so gave me Renakare tablets. A course of antibiotics, Enrofloxacin, Prednisolone in place of the Budesonide, and bupe for pain. She had to call in a prescription for the Lukeran so can't get that until Monday.
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Hi Lisa,
Are these new meds because of the blood work results?
 
Most of them are prescribed due to the blood work. I don't have the results back yet for the EPI. The Chlorambucil is for the suspected lymphoma. I pray I'm not giving him these meds needlessly Kris.
I'm trying not to rush into the "other" option w/o having all the facts and talking to the vet first. I gave him his first dose of antibiotics and prednisolone. The B12 injection I plan to give him on Sunday's.
 
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Yes, most of them are due to results from blood work. The Lukeran is for suspected lymphoma but can't get that until Monday. I need to talk to vet first before making any final decisions. I pray I'm not giving myself false hopes about these meds being able to help him
 
It's very stressful trying to make these decisions. Maybe you'll feel better when you discuss it all with your old vet.
 
He has been Smokys vet since he was a kitten. He was unable to treat him with the advanced health issues that he has.
It's the reason I went to the new vet in the first place. I'm getting ready to go to bed and I'll try to get some sleep.:facepalm:
 
As I said before, give it time. Talk to your old vet to see what he says. Maybe these new meds will perk him up a bit so you can think more calmly about a plan going forward.
 
Thanks Kris, that sounds good to me. :)It's hard to think clearly right now and the lack of sleep is wearing me down.
My friends and my mom are pushing me to have him put to sleep but he's my cat after all.:oops:
 
Prednisolone was a game changer for my civie Theo. I hope it has the same results for your Smoky. Leukeran is not a fast acting drug. It can take a few months to achieve remission. However, once in remission, small cell cats can have a good life for several years. For me I give one pred in a pill pocket per day, then the Leukeran in pill pockets once every two weeks. It's not much work for me. In the US, you can get pred compounded into chew treats at the major on line compounding pharmacies.
 
My vet prescribed him 2 mg of Lukeran twice a week. I mentioned the pulse dosing to her but she didn't know what I was talking about. I can't actually pick it up for him until Monday though.
 
Larry posted the link to the paper describing every two weeks, or pulse dosing. Maybe send that to the vet. It's easier on the cats, and involves less Leukeran so easier on your wallet too.
 
Smokys old vet called me back today to go over the results of his ultrasound. How many vets will do that on a Sunday? It's not looking good for my boy. There are multiple growths showing up on the ultrasound. It's not just in the intestinal wall and both his kidneys are enlarged.
His old vet said renal cancer may be there as well. There is just no way to tell w/o a biopsy being done but I'm not going to do that to him. I have to question why his current vet would suggest all these new meds having read this same report.

I don't know if it's right or not to try and give him the chlorambucil and have him go through possible side effects from that.
I did tell my old vet that I would need a few weeks to make a final decision.
 
Lillie said:
Im so sorry to hear this. I'm sure you'll make the right decision for your boy.
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His old vet said I could try the meds but that I was delaying the outcome. He said I shld ask his current vet why she prescribed all those meds for him. It comes down to his quality of life for me.
 
You old vet is most probably right. The meds could possibly make him feel better for a while, but would probably just delay the outcome. It makes me sad even though it's not my kitty because I know how you feel right now.
 
I was just thinking this morning about Smoky being diagnosed with IBD back in Oct 2016. The new vet I was taking him to suggested using the chlorambucil to treat his IBD. The ultrasound at the time showed some slight thickening of his intestinal wall. I was afraid to try the chlorambucil because it was a cancer drug. The vet also wanted to put him on prednisolone but he was on vetsulin at the time and his BG was in 400-600 range. I was worried the pred would keep it in the high ranges and he was put on budesonide instead. He did so much better after being switched to prozinc.

I was thinking that I should have started him on the chlorambucil and prednisolone back in October and it might have made a huge difference in the long run. I can't go back and start over and now Smoky is in a worse condition. His 12th birthday is coming up on Friday.
Thanks for letting me rant.
 
Lisa and Smoky said:
I was just thinking this morning about Smoky being diagnosed with IBD back in Oct 2016. The new vet I was taking him to suggested using the chlorambucil to treat his IBD. The ultrasound at the time showed some slight thickening of his intestinal wall. I was afraid to try the chlorambucil because it was a cancer drug. The vet also wanted to put him on prednisolone but he was on vetsulin at the time and his BG was in 400-600 range. I was worried the pred would keep it in the high ranges and he was put on budesonide instead. He did so much better after being switched to prozinc.

I was thinking that I should have started him on the chlorambucil and prednisolone back in October and it might have made a huge difference in the long run. I can't go back and start over and now Smoky is in a worse condition. His 12th birthday is coming up on Friday.
Thanks for letting me rant.
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You're allowed to rant. Lisa. You did what you thought was best for Smoky back in October and you couldn't have predicted then that he'd do so much better on ProZinc. None of us has a crystal ball. :bighug:
 
I went through the same kind of thinking with my previous cat who had lymphoma. I kept thinking that if only I had put her on the meds sooner she may have survived. We make the best choices we can at the time with the information we have. My current specialist for Leo told me that even with pred and chlorambucil she has seen the disease progress anyway. It may slow it down some, but eventually she sees it return. I would have done the same thing in giving the budesonide in lieu of pred. due to the diabetes. You did good for Smoky, you took care of him, you regulated his BG, you are a good cat mom and Smoky knows this.
 
Sometimes he gives me this look. Its kind of like " Mom, I'm just really tired"
I talked to his current vet who says she has seen cats do really well on chlorambucil. I don't really like it there though. They act like you're bringing in a car for repairs. They never even talk to Smoky when I've taken him there.
 
Lisa and Smoky said:
Sometimes he gives me this look. Its kind of like " Mom, I'm just really tired"
I talked to his current vet who says she has seen cats do really well on chlorambucil. I don't really like it there though. They act like you're bringing in a car for repairs. They never even talk to Smoky when I've taken him there.
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You're at another of those points like October 2016 where you have something to try but you're worried about the effect on Smoky. It's not an easy decision, given how he's feeling, etc. I'm sorry that the cat vet clinic is so cold and, well, clinical. You could use some advice given in a warm and compassionate manner to compare with what your old vet has said.
 
Smokys original vet doesn't think that the chlorambucil may help him in the long term. He is concerned that all it may do is slow down the disease and cause Smoky to feel even worse from possible side effects from the drug.
 
Lisa and Smoky said:
Smokys original vet doesn't think that the chlorambucil may help him in the long term. He is concerned that all it may do is slow down the disease and cause Smoky to feel even worse from possible side effects from the drug.
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I certainly understand this, Lisa. Such a hard thing to figure out.
 
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