Early relapse of multicentric lymphoma in a dog with concomitant ehrlichiosis and lack of sustained response to lomustine rescue therapy
Case report
DOI:
https://doi.org/10.31533/pubvet.v20n7e1976Keywords:
Chemotherapy, chemoresistance, myelosuppression, anemia, blood transfusionAbstract
Multicentric lymphoma is the most common hematopoietic neoplasm in dogs, and the CHOP protocol (cyclophosphamide, doxorubicin, vincristine, and prednisone) is considered the treatment of choice because of its high clinical remission rates. However, early relapse and resistance to rescue protocols remain major therapeutic challenges. This report describes the case of a 12-year-old mixed-breed female dog previously treated with the CHOP protocol, which achieved complete clinical remission but experienced disease relapse approximately two months after completion of therapy. Based on the clinical suspicion of recurrence, a rescue protocol with lomustine (80 mg/m²) was initiated, resulting in an initial reduction in lymphadenomegaly. Following a temporary interruption of treatment at the owner's request, the disease progressed, with no clinical response to subsequent lomustine administrations, suggesting the development of therapeutic resistance. During disease progression, the patient developed severe anemia and thrombocytopenia, requiring multiple blood transfusions. Hematological investigation revealed a positive serological test for Ehrlichia canis, making it difficult to distinguish hematological abnormalities associated with ehrlichiosis from those related to antineoplastic therapy and possible bone marrow infiltration by lymphoma. Confirmatory diagnostic procedures, including bone marrow aspiration and immunophenotyping, could not be performed because of financial constraints. Despite intensive supportive care, the patient died. This case highlights the aggressive nature of early relapse in multicentric lymphoma, the potential development of resistance to lomustine rescue therapy, and the diagnostic challenges posed by the coexistence of infectious disease and hematological abnormalities. Furthermore, it emphasizes the importance of multidisciplinary management, continuous hematological monitoring, and comprehensive diagnostic investigation in the care of these patients, particularly in the context of disease progression and limited diagnostic resources.
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