Chlorambucil but no Prednisolone for SCL?

[FeebysOwner]

Feeby is 18+yo, with hyperthyroidism, CKD, and arthritis was recently diagnosed with SCL. Her only issues are with intermittent lack of appetite, and what I call lethargy (sleeping a lot and limited mobility). She is being treated for the hyper-T, is taking Mirataz and Ondansetron, although neither seem to affect her strange up and downs with eating for the most part. Her food intake is more or less random. She is receiving Solensia, which seems to be helping with her mobility.

She just had a second opinion oncology vet visit, who does not think Prednisolone is appropriate. This oncologist is not even of the mindset that Chlorambucil is immediately necessary but will administer it if I feel it should be given.

I know every cat's situation is different, but I am trying to find if there are others in a similar situation that have been given advice to forgo Prednisolone, even if they choose to pursue Chlorambucil.

 

[artiemom]

I am sorry, but I cannot offer you any advice, but can only offer you my love and support.

 

[FeebysOwner]

Bumping my own thread up in case there are those who can offer some personal experiences.

 

[daftcat75]

It's often the other way around where they are all too eager to prescribe pred and hesitant to consider chlorambucil. My best guess (and it's only a guess) is that the onc. considered her conditions and medications, and decided that pred would likely be more challenge than benefit. It would help with her appetite. But it would also increase her lethargy. I don't believe in using steroids as an appetite stimulant. Can you email or call the onc back and get clarification? It sounds like a "wait and see" on the chlorambucil. Did you get signs to look for to know when "wait and see" becomes "let's try something"?

 

[FeebysOwner]

It's often the other way around where they are all too eager to prescribe pred and hesitant to consider chlorambucil. My best guess (and it's only a guess) is that the onc. considered her conditions and medications, and decided that pred would likely be more challenge than benefit. It would help with her appetite. But it would also increase her lethargy. I don't believe in using steroids as an appetite stimulant. Can you email or call the onc back and get clarification? It sounds like a "wait and see" on the chlorambucil. Did you get signs to look for to know when "wait and see" becomes "let's try something"?

I am asking for the specific negative impacts related to why Pred is contraindicated in her case, and what of her other conditions to which they might apply. The onc did list the more 'common' things tied to SCL progression, such as diarrhea, vomiting, decreased appetite, and/or high WBC, but I asked if there were others I should be looking out for as well. I also asked if Pred would be reconsidered if/when Feeby would have side effects from the chlorambucil, whenever it is deemed appropriate to start it.

If nothing changes, she still wants to see Feeby in 3 months - and apprised of any changes between now and then.

 

[fionasmom]

Both of my SCL cats were in the position described by daftcat75 . The first one, Milo, was years ago and the vet just threw pred at it. I did not know any better at the time. With Chelsea, it was definitely "let's do pred first and then we will see about anything else." Her case amounted to a decent time on pred only, before the vet was persuaded to add chlorambucil. So, clearly I was not told not avoid pred in either case. And, clearly, this does not answer your question.

Do you think that the onc is one of those vets who is very concerned about long term use of pred and its side effects, therefore in the camp of "risks outweigh benefits" until it is really necessary? Almost like a philosophical stance on its use?

 

[FeebysOwner]

Do you think that the onc is one of those vets who is very concerned about long term use of pred and its side effects, therefore in the camp of "risks outweigh benefits" until it is really necessary? Almost like a philosophical stance on its use?

She included 'textbook' treatment protocols relative to feline SCL in her write up which addressed the use of Prednisolone, so must not be how she feels for all cases. I can only guess her recommendation is due to something specific to Feeby's combined conditions. Hence the reason I am asking for clarification.

As far as delaying administration of chlorambucil, it would seem she believes that since it can lose effectiveness over time, it shouldn't be started 'prematurely'. Use it when you can get the 'biggest bang for your buck' is the only way I know how to interpret it? Maybe why Chelsea's vet took their time with starting chlorambucil?

It just seems like such a different approach from what most on this site have experienced. But it also seems that a lot of these cats were having bigger issues/symptoms at the onset, and perhaps the thought process was to try to alleviate those problems through immediate treatment and give the cat some relief. Probably why both your cats received Pred quickly??

This onc feels that Feeby's SCL was discovered somewhat by accident since that is not why she was undergoing tests/ultrasounds in the first place - and, therefore she believes it is likely very early in its development. She refers to it as an 'indolent' form of lymphoma - meaning it is very slow to develop - so I guess she doesn't see the need to go at it like 'gangbusters' at this point. I dunno...

 

[daftcat75]

Krista's SCL hit like a freight train. We'll never know and my vet will never confirm it. But I think the "all the tuna you can eat" after her remaining teeth were extracted pushed her managed IBD into SCL territory. In her case, we were slow to come to the SCL conclusion because it presented the same as the clostridium infection she had earlier that year: liquid stools. And then the rapid and relentless weight loss. So if Feeby is having good stools and maintaining her weight, her condition is nowhere near as dire and urgent as Krista's was.

 

[fionasmom]

Both of my cats had clear and obvious symptoms of something going on and I agree that they were much farther down the road than Feeby. Milo was years ago, so it is not a fair comparison by today's standards, but Chelsea was well into it, hard to handle, and I had refused any invasive test.

I agree, not being a vet, with the reasoning that the onc is using, meaning it seems logical to me if it is better to wait until you need the meds rather than to start them early.