Leukeran for Cats with IBD

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Tracey&Jones (GA)

Tracey&Jones (GA)

Member Since 2016
Background, was diagnosed with IBS/Pancreatitis this summer. Based upon aspirates done, there was no sign of cancer however we did not do a full biopsy as it seemed very invasive considering the condition he was in (very thin, diarrhea, vomiting, loss of appetite).
Jones' vet is trying to wean him off the prednisolone thinking that is what brought on the diabetes. She wants to do 2.5 mg of prednisolone every second day and then 2mg of leukeran every second day offset from the prednisolone. Has anyone dealt with this protocol before? From what I read leukeran can be a very nasty drug. It seems since starting insulin last week and dropping his prednisolone in half from the 5mg per day that he is doing so much better. He is gaining weight, purring, washing himself. I almost feel like I am a catch 22 situation.
 
Leukeran is a chemo drug, I'd want to make sure you are treating cancer before using it because of those possible side effects. Having said that, my Neko was on Leukeran but she could not have a biopsy due to her heart condition exclusing anesthesia and the ultrasound showed a strong possibility of small cell lymphoma. A better alternative for you might be to try budesonide instead of prednisilone. It works specifically in the gut and is a good choice for IBD. Again, Neko had to go the budesonide route because of her heart. It dosen't raise the blood glucose numbers like pred does.

There are also alternate protocols for Leukeran if you do go that route. There is something called pulse dosing, where you do a larger dose, but just once every two weeks. The overall result is less Leukeran which is easier on kitty (can cause nausea) and your wallet. There is no reason to offset the Leukeran from the steroid dosing.

What food are you feeding? Diet is an important factor in IBD. See http://www.ibdkitties.net/
 
Wendy&Neko said:
What food are you feeding? Diet is an important factor in IBD
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I am feeding a combination of the Science diet ID chicken pate and Purina DM. Sometimes receives the Science Diet ID chicken stew. Treats are the SD ID and whiskas. He is at a stage that poops are almost normal looking, volume of feces is way down, there is less poops. I think I have a good combination going right now. Still need to get his BD down, but we only been at this for a week now.
 
Wendy&Neko said:
ultrasound showed a strong possibility of small cell lymphoma
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That is the thing, it showed larger than normal lymph nodes and intestinal walls however the aspirates for both came back negative. Doesn't mean there isn't cancer just that none were showing up at that time. Considering everything was really out of control at that point including his WBC, which has since normalized....just leaves questions in the back of my mind. She is an excellent vet, saved my dog from IMHA with no re-occurrence for 5 years and my other dog and all her cancer issues and treatments. I just know on this one...seems going that extra mile to
"be extra safe" is a little much considering what he has been through. I will ask on the budesonide. The Leukeran was $108 CAD for 25 pills. Even if insurance will pay 90% that is a high priced pill.
 
Tracey&Jones said:
The Leukeran was $108 CAD for 25 pills
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Yikes, more than I pay in BC. Budesonide can also be compounded. I found it cheaper compounded (liquid fish flavour) than the pills and easier to give. Lymph nodes can still be larger with just IBD. Fine needle aspirates are not a small cell diagnosis method. You can also use endoscopy, if the inflammation is in a location the scope can reach, but it still needs anesthesia. The fact that he's gained weight is a good sign. Neko went to an internal medicine vet for her IBD/lymphoma - she had a few other complications too that made the local vet throw up her hands. The IM vet consulted with the oncologist at the clinic, and the cardiologist, so I felt pretty comfortable with their advice.

The Science Diet looks like it's pretty high carb food (contains wheat gluten, rice, rice starch, powdered cellulose?:eek:), which isn't the best for diabetics. It also has guar gum which many IBD kitties react to. You don't need to feed veterinary foods, there are plenty of good quality commercially available foods that may work. But don't change the food unless you are home testing his blood sugars, as his insulin dose needs may be less on lower carb food. And of course, any food changes would have to be done slowly.
 
:nailbiting:
Wendy&Neko said:
You don't need to feed veterinary foods, there are plenty of good quality commercially available foods that may work. But don't change the food unless you are home testing his blood sugars, as his insulin dose needs may be less on lower carb food. And of course, any food changes would have to be done slowly.
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:)

I feel the same way that there is better food options available. :bookworm: However, I am at the frame of mind right now that if it isn't broke let's not fix it- at least for the next little bit. I am currently slowly changing from the ID to the Purina DM diet and will be researching other options. He seems happy for now, blood work has improved on the IBS/Pancreas side, his stool has improved, his BS levels are stabilizing after first starting the insulin and his appetite has increased. AND HE IS PURRING AGAIN! I think I will stay with what we have and continue working on the diabetic side of things see if the current diet changes are having an effect. Get things in balance and then start changing doses, meds (or not) (leukeran vs. budesonide) and any further diet changes that may be required (DM vs. IBS diets; raw vs. other). One step at a time and let Jones tell me what is working and what isn't.

Am doing home blood sugars, not as bad of a process as I thought it would be.

Thank you for your feedback. It always helps to talk things out and see if what you are thinking/feeling is on the right track or not.
 
A caveat before I write my reply - I'm pretty new to both diabetes and IBD/pancreatitis. However, my boy was recently started on Leukaran (Chlorambucil - compounded form - much cheaper - I paid $37.95 USD for 20 pills + $10 shipping because it needs to stay cold). Like you, I freaked out when I read up on it and called my specialist and basically said, what am I giving my cat? I'm not sure if you're on the Facebook board IBDKitties, but there are a number of cats on there that are using Leukaran (Chlorambucil) with good results - the few that didn't, didn't have anything as close to as bad as what I read online while searching it. Many giving the Leukaran don't know if they're dealing with IBD or lymphoma (some do). In my case, my boy has confirmed severe IBD via biopsy (no lymphoma); however, apparently Leukaran is sometimes used in kitties not reacting well enough to pred in a situation where they don't want to keep them on a high ongoing dose. My specialist originally mentioned Budesonide, but then decided we should skip over that and go straight to Leukaran. If you do hit a stage where you feel like you might want to try the Leukaran, I'd recommend posting on the IBDKitties Facebook group - lots of useful help there in dealing with this drug. If you do start it, you will need routine blood tests for your kitty, as if certain numbers do start to show an effect, they'll discontinue using this for awhile.
 
I don' believe we can get compounded Leukeran in Canada, except in liquid form, which has less than a week shelf life so essentially not do any use.

Good to hear Jones is purring again. That is huge! :) And I agree on going slow on the food changes, especially with IBD kitties.
 
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Tara L said:
A caveat before I write my reply - I'm pretty new to both diabetes and IBD/pancreatitis. .
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Jones started the Leukeran after much talking with the vet and a tech at the clinic that just started it with her kitty.. Checked out the the facebook group your mentioned and did some reading. Helped relieve some fears I would say for the most part, he is doing ok on it (blood work in another week) though seems very tired on dosage day. That said, we have dropped his steroid dose in half and upped his Lantus dose to 3 units x2. His BS is improving...got a 14.5 (down from our 21-25 range!) , lowest I seen since we started this. Hope things are going well with you and your kitty.
 
I had a kitty with small cell GI lymphoma (not diabetic) and we started her on Prednisolone and Leukeran 2 mg every 3 days. After 1 month she crashed from the Leukeran so we had to switch to 1 mg compounded Chlorambucil every other day. The 1 mg had to be compounded since 2 mg is the smallest Leukeran pill they manufacture. She tolerated the 1 mg very well.

Our small cell lymphoma kitty lived 18 months post-diagnosis and is now at the Bridge, but now I have two IBD kitties and one is diabetic. We recently started the diabetic IBD kitty on Budesonide and it is addressing her IBD issues, but it has elevated her BG, which I was hoping would not happen. Oh well!

Finally, I will say that I am not a fan of compounded drugs since they are not regulated and there is the possibility of inconsistency and efficacy issues. Most compounded drugs have not been studied to determine if they are as effective as the original form. So IMHO you are always better off with the original form of a drug and I only use compounded when it is the only option either because of cost or the kitty not being able to take the original form. If Chai had tolerated the 2mg of Leukeran I would have stayed with that since we have insurance that paid 90%. But I totally understand that it is prohibitively expensive for many people.

The IBD Kitties FB group is an excellent resource.

Jeanette
 
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