The last post focused on the newest version of a canine “Bone Marrow Transplant.” In a nutshell, this is a brand-new procedure that may produce a good number of actual dog cancer cures. Curing canine cancer essentially unheard of in conventional veterinary care using chemotherapy, radiation, and surgery, at least with the systemic dog cancers.
This new procedure is called Autologous Peripheral Blood Stem Cell Transplantation.
Very briefly, the patient is treated with chemo to remission, then a week of antibiotics and Cytoxan. Then a stretch of Neupogen which boosts stem cells in the blood which are harvested pretty simply from a vein. There is no bone marrow used. Next is Total Body Irradiation (TBI) to kill remaining cancer cells. The stem cells are then transfused into the dog to repopulate the body with healthy cells.
Anticipated cure rate in many cases of lymphosarcoma? About 6 in 10!
So what are the down sides to consider before embarking on this journey? First is cost. The bill may be around $15,000 on the low end. Second is location: you may not live close to North Carolina State College of Veterinary Medicine, which is where the procedure is available, although you may be able to get a similar procedure done at Bellingham Veterinary Critical Care in Washington State. The bill there will likely be higher there than at NC State.
You need to make sure you have a veterinarian’s referral, which may mean you need to sit in the driver’s seat in more ways than one.
Count on a hospital stay for your dog of roughly 3 weeks, give or take. That , depending on your viewpoint, may be a long time of separation.
Once there, we need to consider the treatments. This is not mickey-mouse stuff. Not only are we looking at Cytoxan and Neupogen, which can be strong drugs with some side effects, we have to deal with Total Body Irradiation. Radiation therapy can have its drawbacks.
Nausea, lethargy and digestive upset would be expected following TBI. Sometimes the skin reacts to the beam like a severe sunburn. Occasionally stomatitis develops, which is a painful inflammation of the lining of the mouth. Low blood cell counts can occur, and secondary infections (these would be in addition to similar effects from cyclophosphamide).
This stuff is most often manageable. However, the parts that many overlook include a syndrome called delayed radiation toxicity, as well as the development of secondary cancers due to the radiation itself. Months or years after radiation is performed, delayed radiation toxicity can rear it’s ugly head.
This can be seen as cataracts with vision loss, kidney disease, bone and ligament damage, fibrosis of the lung, injury to the liver, and other issues.
The incidence of secondary cancers in dogs later in life due to TBI are five times higher than dogs who do not receive radiation. If one where to look the odds of a young dog getting TBI, and this dog lives to ten years of age, there is a very high probability there will be a secondary cancer from the radiation. You could almost expect it, since estimates are that 50% of dogs that did not receive TBI (normal dogs) over 10 years old succumb to cancer as cause of death.
Five times that? Ouch.
By the way, there are steps that can be taken to help with these potential side effects. They are discussed, along with other ways of mitigating adverse reactions, in the Dog Cancer Survival Guide.
The take home message here is that we need to be armed with data before embarking on a treatment plan. I think this development has huge potential. Meanwhile though, we must know what could happen. We need to be alert to signs so we can react earlier. We need to be emotionally prepared to deal with crises that could arise from treatments. And most importantly perhaps, we need to assume responsibility for our choices.
Best to all,
Dr D
Many of us have heard of bone marrow transplants used in people with cancers. In the last few years, bone marrow transplants have become available for dogs too. Ironically, it was dogs that served as the models for development of the technology in people more than 3 decades ago.
Finally, they are benefiting from the procedure they sacrificed for.
First, let’s look at the benefits. Systemic cancer is hardly ever cured in dogs with conventional veterinary care. Sure, there are exceptions, maybe a couple percent of these dogs. For the most part, we are looking to only make things better for a period of time if we stick to just chemo, surgery and radiation.
With bone marrow transplants, things may change. It is not easy, simple, nor without risks, but if dogs turn out like people, certain lymphosarcoma cases could be looking at a cure rate of roughly 6 in 10. Those are huge numbers, folks.
The cancers treated with the newest approach involve cancerous white blood cells in the circulation. Lymphosarcoma is the most common, with lymphoblastic leukemia also being treated. I am not aware of other cancer types being treated with this procedure currently, but that does not exclude them.
“Bone marrow transplant” is a horrible name for what is going on these days. It does not involve the bone marrow directly, nor does it involve moving it from one location to another. The procedure that is most exciting currently is Autologous Peripheral Blood Stem Cell Transplantation. It takes, very roughly, three weeks of hospital time.
Here is a brief summary of this procedure in an ideal world:
Chemo puts the cancer in remission. Healthy stem cells used to repopulate the bone marrow are harvested. Radiation is used to kill remaining cancer cells. Healthy stem cells are put back in the patient and life is good.
Cost from the College of Veterinary Medicine at North Carolina: about $15,000.
It is not that simple however, as you will see. Let’s look at more details.
Autologous indicates that the patient is the donor, not another dog. The bone marrow is not harvested. Instead, blood taken from a vein that is collected through a port. It is then pumped into a machine which is able to filter out and remove healthy, non-cancerous stem cells.
These stem cells are capable of growing into un-diseased cells that would arise from the bone marrow. The separation of these cells is called leukaphoresis, and the machine is aptly called a leukaphoresis machine. The blood, following stem cell removal, is pumped back into the patient.
Here is a link for more information and a video of what this looks like.
However, before all of this can happen, the dog must be primed for the leukaphoresis procedure. Not only must the cancer be in total remission, there can be no infection or exposure to microbes. The patient is treated with antibiotics and the chemo drug cyclophosphamide (Cytoxan) before-hand.
Next, a week of rest is given. Then a drug called Neupogen is used for six days to boost the stem cell levels in the blood before they are collected. On days 6, leukaphoresis is done. Leukaphoresis requires about 3 hours (more or less) of general anesthesia, but does not appear to be painful. The stem cells are stored.
The next day is radiation day. This is also done under general anesthesia. Radiation is performed to try to kill the cancer cells that are resting dormant (in remission) from the chemo. Total Body Irradiation (TBI) is when a dog’s entire body is exposed to radiation.
The idea behind TBI is that if there is cancer in the circulation, like lymphosarcoma, you cannot point the radiation beam at a single tumor since the cells are traveling around the body. So the whole body gets dosed.
Finally, it is time for transfusion of the crop of stem cells from the luekaphoresis procedure done beforehand. They are taken out of storage to be transfused immediately after the irradiation.
Then we have about 2 weeks of supportive care in the hospital. Blood testing is done during this time to monitor the effects of the radiation on the body’s bone marrow cells.
The least costly way, I believe, to get this procedure done for your dog is through the College of Veterinary Medicine at North Carolina State University. Please note that the procedure is done only after a referral from your veterinarian.
Another procedure involving blood donations from a dog’s family (allogeneic stem cell transplants) has been available through Bellingham Veterinary Critical Care in Washington State.
As usual, be your dog’s number one health care advocate!
In the next post, I will examine some of the other details of this procedure. For more on cutting-edge treatments, both conventional and “outside the box” that you can independently research and pursue, check out the Dog Cancer Survival Guide.
Best to all
Dr D
I recently got a comment from a reader who was quite upset with her veterinarian.
Turns out her dog underwent a splenectomy (spleen removal), presumably for treatment of a hemangiosarcoma (a malignant tumor of the blood vessel walls) of the spleen. This dog lover was incensed that the vet indicated this procedure, combined with removal of a lipoma (fatty tumor) at the same time, would extend her dog’s life for a “long time”.
Following the splenectomy, she was dismayed to find out, according to certain people, that this procedure would only extend her dogs life for an additional 3-6 months. Whereupon she became “furious” at her vet, reasoned that the vet was trying to get her money, and sent in the comment. My quotes indicate her wording.
I think there are various aspects to this scenario that deserve attention.
First and foremost, hindsight is 20-20. In cases of dog cancer, foresight is never 20-20. However, foresight can be sharpened considerably by education. I often will ramble on about “being your dog’s number one health advocate” and stress how information gathering is one of the initial steps that must be taken.
Most of us will research before buying a car. However, the health professional industry, over probably thousands of years, has created a mass-consciousness belief that information from a Doctor should not be questioned. I am sure that a whole book could be written about how and why this came about. Regardless of the genesis of this belief, it is now counter-intuitive for us to gather our own data about the care of our four legged family members.
Being your dogs primary health care advocate implies that the information is gathered before the action is executed. Although it is not always natural, I think it is so important for everyone to please try to gather as much data as you can before embarking on what can be a complicated journey. This was one of my main reasons for writing the Dog Cancer Survival Guide.
In the case of this blog reader, it could be argued that, from her vet’s perspective, the removal of the spleen would indeed extend her dog’s life for a long time. What does that phrase mean, anyway? A “long time”?
If one were to look at years of life in proportion to lifespan, a one year would be half the life of a creature expected to live two years. A year would indeed be a long time for this creature.
One year, in a dog with an average life expectancy of 12 years, is 8.3% of this dog’s life. (Here is a good link for average life expectancies.) Suppose a human were to live 80 years. 8.3% of that 80 years would be 6.67 years.
How about, say, 7 months for a dog? Well, for a dog expected to live for 12 years, this turns out to be 3.88 years of life for a human with a life span of 80 years.
Is 3.88 years a long time for a human? I don’t know. Could be. I guess it depends on your viewpoint.
A dog with a splenectomy following hemangiosarcoma and no further care of any kind could live 3 months (more than 1.5 “human” years) or longer. With chemo maybe 7, and with diet, supplements, and the rest of the full spectrum plan maybe much longer. Every dog is different. These details are included in the Guide.
Anyway, the bottom line is this: everything is relative. Gather the data before you set sail and do what makes sense to you while using “compass”-ion as your compass.
Best to all,
Dr D
I have been hearing that the economy is about to take an up turn. There is this very tentative “maybe” built in to the statement, and sadly, it is not making any one’s life easier.
When one looks at these forward-leaning claims, the problem is that they don’t rest in what is really going on now. Okay, “about” to get better. That would suggest that at this stage, in the present moment, things are the same.
And realizing this, it can be pretty bleak for many dog lovers dealing with canine cancer.
I have had people in my veterinary hospital tell my they have to choose between their dog’s food and their own. Or their childrens’ needs and those of their dogs.
Indeed, for many, these dog days are ruff days (sorry, had to lighten it up a little…)
So, what to do when faced with the cost of caring for a dog with cancer? In the Dog Cancer Survival Guide, there is a listing of sources of possible financial help. But today I wanted to highlight what for many, has been a magic bullet.
The Magic Bullet Fund is a resource for people who are in need of financial help for their dogs’ cancer treatment. The Magic Bullet Fund is a real-life, practical, well-orchestrated answer to a pressing need.
The process is fairly strait-forward. One must apply, and then the applications are screened. Approval is for funding is granted for those where treatment is hoped to yield at least a year or more of life.
Palliative treatment is viewed as yielding less than this, and these efforts are excluded from the Fund. This means that if the treatment does not have a decent probability of adding a year to your dog’s life, you may not be approved.
The money is ear-tagged for care of dogs with cancer only, for people who are in real financial need. The money is not used for research or other scientific pursuits, only to fund treatment.
If you would like to apply for assistance, or if you would like to make a contribution to help those in need, check out the Magic Bullet Fund:
http://www.themagicbulletfund.org
Best to all in these ruff days,
Dr D
It is clear that dogs with cancer, at least with true, aggressive forms of cancer, have some special needs. I would like to give you some information about a special need that is often overlooked.
Dogs with a cancer diagnosis should have their temperatures taken on a regular basis. If a dog is on chemotherapy, it should be daily. If your dog is acting ill and has cancer, even if not on chemo, it should also be daily (and your canine companion should be seen by a vet). If your dog is afflicted with cancer but is acting fine, it should be every few days or so.
Why does it matter? Don’t we pay attention to fevers when a dog has an infection?
Well, in cancer management, body temperature is important too. This is particularly true when a dog is on chemotherapy. Many, perhaps even most, chemotherapy drugs are capable of a side effect called bone marrow suppression.
To understand what this means, we need to back up a little. We know that white blood cells fight infection in our bodies, and our dogs’ as well. One critical type of white blood cell is called the neutrophil. This little guy matures in the bone marrow and is then released into the blood stream to fight invading microbes if they are present.
When a drug causes bone marrow suppression, one of the cell types that gets hit hard (suppressed) in the bone marrow is the neutrophil. This translates into very low neutrophil counts. When a dog’s body has low neutrophil counts, the usual degree of protection from incoming microbe invaders is lost.
A dog on chemotherapy with a fever coupled with low neutrophil counts is a medical emergency. Microbes that are usually weak are able to gain access into the body under these circumstances and wreak havoc. Strong germs are life threatening.
Even dogs not on chemo who are fighting aggressive cancers are prone to infection. Cancers are able to create what is called immune compromise, which is when the immune system is “under the weather” compared to normal. These dogs are susceptible to infection as well and should also have their temperatures taken every few days.
The normal body temperature of a dog is 100.5 -102.5 degrees Fahrenheit (you will find some variation in the reported normals, but this is one of the most common published ranges). Note that this is the core body temperature, not the temperature of the skin. The skin temperature is not reliable and a dog who is “feeling warm” may not have a fever.
Remember that dogs who have just exercised have elevated body temperatures, and these will drop once the animal settles down. So remember to take your dog’s temperature at rest.
If your dog has a fever, he or she needs veterinary attention!
Here is a little link on how to actually do it. A digital thermometer or a glass one can be used. I lean towards the digital thermometers as they more are difficult to break.
Remember to make a note on the packaging for future reference that the instrument is for dogs and not people….
Best to all,
Dr D
