Meet Our Latest Case: A Brave Pup Facing T-Cell Lymphoma

16th December 2024 by Magda Gerou-Ferriani

A 5-year-old canine crossbreed presented with persistent PU/PD (polyuria and polydipsia) and mild hypercalcaemia, leading to a diagnosis of T-cell lymphoma. While hypercalcaemia caused concern for kidney function, a thorough diagnostic workup—including lymph node cytology and PARR testing—helped us pinpoint the underlying cause.

T-cell lymphoma, often paired with paraneoplastic hypercalcaemia, presents unique challenges in management, requiring a delicate balance between aggressive treatment options and quality of life considerations.

From single-drug protocols to comprehensive multidrug chemotherapy, we provided a range of options tailored to the patient's needs and the carers’ preferences. Ultimately, our focus is always on optimizing care and ensuring informed decisions for each case.

Stay tuned as we dive into this case, exploring the journey from diagnosis to treatment planning and the importance of addressing metabolic complications early! ✨

📍 Case handled at Medivet Godstone Referrals.
💡 Specialist support makes all the difference in tackling complex cases.

Case Details:

Patient: A 5-year-old female neutered crossbreed, weighing 27.8 kg, fully vaccinated, and regularly dewormed.
Clinical Signs: Polyuria, polydipsia, mild hypercalcaemia, reduced appetite, and palpable pre-scapular and popliteal lymph nodes.

Diagnostics and Findings:

CBC: Mild thrombocytopenia (70x10⁹/L) and neutropenia, possibly stress-related.
Biochemistry: Hypercalcaemia (3.61 mmol/L) and mild elevation in liver enzymes.
Ionized Calcium: Elevated (2.08 mmol/L; normal <1.5).
PTH/PTHrP: Negative, ruling out primary hyperparathyroidism and paraneoplastic secretion.
Abdominal Ultrasound: No significant abnormalities.
Lymph Node Cytology: Suspicious for lymphoma; PARR testing confirmed T-cell lymphoma.

Diagnosis: Stage III, substage b, T-cell lymphoma with paraneoplastic hypercalcaemia.

Treatment Options:

Single-drug protocol (Prednisolone alone): Palliative care with MST of 4–8 weeks.
Oral chemotherapy (Lomustine + Prednisolone): MST of 3–4 months, with liver enzyme monitoring required.
Single-agent intravenous chemotherapy (e.g., Doxorubicin): MST of 5–6 months, with potential for gastrointestinal upset and myelosuppression.
Multidrug chemotherapy (CHOP/LOPP): MST of 6–9+ months, requiring close monitoring for side effects.

Discussion:
T-cell lymphoma is an aggressive cancer in dogs, accounting for 20–40% of canine lymphomas. Hypercalcaemia, a hallmark of this disease, necessitates urgent management to prevent renal damage. The therapeutic approach must balance the invasiveness of treatment with the patient's quality of life.

In this case, options were discussed with carers, considering both the patient’s stress levels and the family’s preferences. Whether pursuing palliative care or intensive protocols, ensuring informed decision-making and prioritizing the patient’s comfort remain our core goals.

✨ Key Takeaway: Early detection and intervention in cases of hypercalcaemia are vital to prevent irreversible damage. At Medivet Godstone Referrals, we tailor treatment plans to suit each patient’s needs while ensuring carers feel supported and informed.🐾