개에서 발생한 피부 상피친화성 T-세포 림프종: Lomustine 및 Gemcitabine에 대한 임상적 반응 Cutaneous Epitheliotropic T-Cell Lymphoma in a Dog: Clinical Responses to Lomustine and Gemcitabine원문보기
5년령의 중성화된 암컷 말티즈가 1개월 동안 지속된 전신적 발적, 탈모 및 소양감으로 내원하였다. 피부조직구증으로 진단되어 면역억제치료를 1개월 간 지속하였지만 다발성의 발적된 반 및 판 병변들이 새롭게 발생하였다. 피부병변에 대한 압박도말검사에서 림프종을 지시하는 원형세포들이 관찰되었다. 조직학적 검사에서는 종양세포들의 외피 및 부속구조물에 대한 친화성이 나타났다. 면역염색결과 종양세포들은 CD3에 대하여 양성, CD79a에 대해서는 음성반응을 나타내어 피부 상피친화성 T-세포 림프종으로 확진하였다. $70mg/m^2$의 lomustine을 2-3주 간격으로 총 2회 투여하였으며 부분적인 치료반응이 관찰되었다. 피부병변의 악화와 lomustine의 이용제한으로 gemcitabine ($500mg/m^2$, 1주일당 1회 30분간 혈관주입)을 이용한 화학치료를 시작하였다. 총 3회 치료가 실시되었으나 질병의 진행을 억제하지 못하였으며, 최초 lomustine 치료 69일 후 안락사 되었다.
5년령의 중성화된 암컷 말티즈가 1개월 동안 지속된 전신적 발적, 탈모 및 소양감으로 내원하였다. 피부조직구증으로 진단되어 면역억제치료를 1개월 간 지속하였지만 다발성의 발적된 반 및 판 병변들이 새롭게 발생하였다. 피부병변에 대한 압박도말검사에서 림프종을 지시하는 원형세포들이 관찰되었다. 조직학적 검사에서는 종양세포들의 외피 및 부속구조물에 대한 친화성이 나타났다. 면역염색결과 종양세포들은 CD3에 대하여 양성, CD79a에 대해서는 음성반응을 나타내어 피부 상피친화성 T-세포 림프종으로 확진하였다. $70mg/m^2$의 lomustine을 2-3주 간격으로 총 2회 투여하였으며 부분적인 치료반응이 관찰되었다. 피부병변의 악화와 lomustine의 이용제한으로 gemcitabine ($500mg/m^2$, 1주일당 1회 30분간 혈관주입)을 이용한 화학치료를 시작하였다. 총 3회 치료가 실시되었으나 질병의 진행을 억제하지 못하였으며, 최초 lomustine 치료 69일 후 안락사 되었다.
A 5-year-old, spayed female Maltese dog presented with generalized multifocal pruritic erythema and alopecia for a month. Initial skin biopsy suggested cutaneious histiocytosis. The dog had been treated with the immunosuppressive therapy for a month, but multifocal erythematous patches and plaques w...
A 5-year-old, spayed female Maltese dog presented with generalized multifocal pruritic erythema and alopecia for a month. Initial skin biopsy suggested cutaneious histiocytosis. The dog had been treated with the immunosuppressive therapy for a month, but multifocal erythematous patches and plaques were newly observed. Direct imprint smear of cutaneous lesions suggested a lymphoma and rebiopsy was performed. Microscopic examination demonstrated a round cell tumor with epitheliotrophism to the epidermis and adnexal structures. The neoplastic round cells were strongly positive for CD3 yet negative for CD79a, indicting the tumor was cutaneous epitheliotropic T-cell lymphoma. After 2 cycles of oral administration of lomustine ($70mg/m^2$, once every 2-3 weeks), only partial response was observed. Alternative chemotherapy with gemcitabine ($500mg/m^2$, 30-minute IV infusion, once every week) was initiated. A total 3 cycles of gemcitabine failed to control the progression of disease, and the dog was euthanized on Day 69 after the 1st lomustine treatment.
A 5-year-old, spayed female Maltese dog presented with generalized multifocal pruritic erythema and alopecia for a month. Initial skin biopsy suggested cutaneious histiocytosis. The dog had been treated with the immunosuppressive therapy for a month, but multifocal erythematous patches and plaques were newly observed. Direct imprint smear of cutaneous lesions suggested a lymphoma and rebiopsy was performed. Microscopic examination demonstrated a round cell tumor with epitheliotrophism to the epidermis and adnexal structures. The neoplastic round cells were strongly positive for CD3 yet negative for CD79a, indicting the tumor was cutaneous epitheliotropic T-cell lymphoma. After 2 cycles of oral administration of lomustine ($70mg/m^2$, once every 2-3 weeks), only partial response was observed. Alternative chemotherapy with gemcitabine ($500mg/m^2$, 30-minute IV infusion, once every week) was initiated. A total 3 cycles of gemcitabine failed to control the progression of disease, and the dog was euthanized on Day 69 after the 1st lomustine treatment.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
Initial therapy was performed using a lomustine protocol (13,15). A CBC and serum chemistry profile required for assessment of toxicities was performed at 6 to 10 days interval after the 1st chemotherapy (Table 1). The severities of toxicoses were graded from 1 (mild) to 4 (most severe), according to the reported criteria (Table 1) (14).
Moreover, erythematous scaly patches were generalized and new crusted lesions developed on the neck. A skin biopsy was performed for histologic analysis, and the findings were suggestive of cutaneous histiocytosis. Skin lesions had been gradually decreased until 2 weeks after the immunosuppressive therapy with prednisone (2 mg/kg twice daily) and azathioprine (2 mg/kg once daily).
Because gemicitabine is widely used in the treatment of refractory CETL in human, alternative chemotherapy was initiated at 43 days after the 1st lomustine treatment, according to a modification of gemcitabine protocol in dogs (7). A total 3 cycles of gemcitabine (500 mg/m2, 30-minute IV infusion, once every week; Gembine Inj., Hanmi, Korea) was administered. At 1 week after the 1st gemcitabine treatment, erythema and edematous lesions were mildly decreased, but neutropenia (1,440 cells/µL, grade 2) and plaques on the head, dorsum, and ventrum were newly developed (Fig 1e).
The dog was treated orally with cephalexin (30 mg/kg twice daily for 1 week), itraconazol (10 mg/kg once daily for 1 week), and ivermectin (300 µg/kg once daily for 1 week) without marked improvement.
대상 데이터
A 5-year-old, spayed female Maltese dog was presented due to one month duration of generalized erythema, alopecia, and pruritus. The lesions were described as erythema and focal alopecia of the face, neck, dorsum, legs, and tail.
참고문헌 (15)
Baines SJ, McCormick D, McInnes E, Dunn JK, Dobson JM, McConnell I. Cutaneous T cell lymphoma mimicking cutaneous histiocytosis: differentiation by flow cytometry. Vet Rec 2000; 147: 11-16.
Bhang DH, Choi US, Kim MK, Choi EH, Kang MS, Hwang CY, Kim DY, Youn HY, Lee CW. Epitheliotropic cutaneous lymphoma (mycosis fungoides) in a dog. J Vet Sci 2006; 7: 97-99.
Duvic M, Talpur R, Wen S, Kurzrock R, David CL, Apisarnthanarax N. Phase II evaluation of gemcitabine monotherapy for cutaneous T-cell lymphoma. Clin Lymphoma Myeloma 2006; 7: 51-58.
Kosarek CE, Kisseberth WC, Gallant SL, Couto CG. Clinical evaluation of gemcitabine in dogs with spontaneously occurring malignancies. J Vet Intern Med 2005; 19: 81-86.
Marchi E, Alinari L, Tani M, Stefoni V, Pimpinelli N, Berti E, Pagano L, Bernengo MG, Zaja F, Rupoli S, Pileri S, Baccarani M, Zinzani PL. Gemcitabine as frontline treatment for cutaneous T-cell lymphoma: phase II study of 32 patients. Cancer 2005; 104: 2437-2441.
Moore AS, London CA, Wood CA, Williams LE, Cotter SM, L'Heureux DA, Frimberger AE. Lomustine (CCNU) for the treatment of resistant lymphoma in dogs. J Vet Intern Med 1999; 13: 395-398.
Morrison WB. Lymphosarcoma. In: Cancer in Dogs and Cats: Medical and Surgical Management, 2nd ed. Jackson, WY: Teton NewMedia. 2001: 641-670.
Rassnick KM, Moore AS, Williams LE, London CA, Kintzer PP, Engler SJ, Cotter SM. Treatment of canine mast cell tumors with CCNU (lomustine). J Vet Intern Med 1999; 13: 601-605.
Risbon RE, de Lorimier LP, Skorupski K, Burgess KE, Bergman PJ, Carreras J, Hahn K, Leblanc A, Turek M, Impellizeri J, Fred R 3rd, Wojcieszyn JW, Drobatz K, Clifford CA. Response of canine cutaneous epitheliotropic lymphoma to lomustine (CCNU): a retrospective study of 46 cases (1999-2004). J Vet Intern Med 2006; 20: 1389-1397.
Veterinary Co-operative Oncology Group. Veterinary Cooperative Oncology Group - Common Terminology Criteria for Adverse Events (VCOG-CTCAE) following chemotherapy or biological antineoplastic therapy in dogs and cats v1.0. Vet Comp Oncol 2004; 2: 195-213.
Williams LE, Rassnick KM, Power HT, Lana SE, Morrison- Collister KE, Hansen K, Johnson JL. CCNU in the treatment of canine epitheliotropic lymphoma. J Vet Intern Med 2006; 20: 136-143.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.