Relevância da imunofenotipagem no outcome clínico em cães com linfoma
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2024
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O linfoma canino é uma das doenças neoplásicas diagnosticadas com maior frequência no cão, sendo considerada uma das três neoplasias mais comuns nesta espécie. Uma das ferramentas de diagnóstico disponíveis para os médicos veterinários é a imunofenotipagem. O imunofenótipo do linfoma, que pode ser B ou T, é um fator de prognóstico forte, servindo para prever o desenvolvimento clínico da doença. Vários estudos identificaram o imunofenótipo T como sendo o mais agressivo, apresentando uma taxa de resposta à quimioterapia, duração da resposta, período de remissão e sobrevida inferiores ao imunofenótipo B. Este estudo retrospetivo pretendeu investigar a influência do imunofenótipo na escolha do protocolo terapêutico e outcome clínico em cães com linfoma canino. O estudo, realizado com informação recolhida no ARHV, analisou retrospetivamente vinte e nove casos de cães entre janeiro de 2018 e junho de 2023, com historial clínico documentado, um diagnóstico de linfoma, imunofenotipagem realizada e com, no mínimo, quatro sessões de quimioterapia realizadas. Com os dados recolhidos, foi construída uma base de dados e realizada a sua análise estatística. A maioria dos linfomas era de imunofenótipo B (n=24, 82,8%), sendo os restantes (n=5, 17,2%) de imunofenótipo T. Apesar de não ser estatisticamente significativo, os cães com linfoma de imunofenótipo B apresentaram, em média, um tempo de sobrevida superior aos de imunofenótipo T. Apenas 8 cães (27,6%) começaram um protocolo quimioterápico após a realização da imunofenotipagem, com os restantes 21 (72,3%) a iniciarem um protocolo antes de saberem o imunofenótipo do linfoma. O CHOP foi o tratamento mais utilizado como primeira abordagem em mais de 90% dos casos (n=27, 93,1%). Os restantes protocolos utilizados como primeira abordagem foram o LOP (n=1, 3,4%) e um protocolo constituído por lomustina, prednisona ou prednisolona (LP) (n=1, 3,4%). Dos 21 cães, apenas 3 (14,3%) sofreram uma alteração do protocolo depois de saberem o imunofenótipo. Destes 3, 2 (66,6%) eram de imunofenótipo T, não sendo, no entanto, a correlação estatisticamente significativa. Foi obtida uma correlação positiva entre o imunofenótipo e cálcio ionizado aumentado no momento do diagnóstico, que corresponde ao descrito na literatura. Até à data desta dissertação, não existiam estudos a demonstrar um possível impacto positivo ou negativo do imunofenótipo na alteração do protocolo, sendo esta dissertação o primeiro estudo sobre este tema. O tamanho da amostra foi a limitação principal deste estudo e, apesar de não ter sido obtida uma correlação positiva entre o imunofenótipo e a alteração do protocolo terapêutico, este é um tema que requer investigações adicionais. Sem estudos prospetivos significativos que avaliem protocolos alternativos em imunofenótipos específicos, em particular o T, a imunofenotipagem irá continuar a servir principalmente como ferramenta de prognóstico no desenvolvimento oncológico, em vez de uma ferramenta com influência nas decisões do tratamento. Palavras-chave: linfoma canino; imunofenotipagem; outcome clínico; protocolo terapêutico; oncologia veterinária.
Canine lymphoma is one of the most frequently diagnosed neoplastic diseases in dogs, being considered one of the three most common neoplasms in this species. Immunophenotyping is one of the diagnostic tools available to veterinarians. The immunophenotype of lymphoma, which can be B or T, is a strong prognostic factor, helping predict the clinica l development of the disease. Several studies have identified the T immunophenotype as the most aggressive, showing a lower response rate to chemotherapy, shorter re sponse duration, remission period, and survival compared to the B immunophenotype. This retrospective study aimed to investigate the influence of the immunophenotype on the choice of therapeutic protocol and clinical outcomes in dogs with canine lymphoma. The study, conducted using information collected from the ARHV, retrospectively analyzed twenty nine cases of dogs between January 2018 and June 2023 , with documented clinical history, a diagnosis of lymphoma, immunophenotyping testing performed , and a minimum of four chemotherapy sessions. A database was constructed with the collected d ata, and statistical analysis was performed. The majority of lymphomas were of the B immunophenotype (n=24, 82.8%), with the remaining cases (n=5, 17.2%) being of the T immunophenotype. Although not statistically significant, patients with B immunophenotype lymphoma had, on average, a longer survival time than those with T immunophenotype. Only 8 dogs (27.6%) started a chemotherapy protocol after immunophenotyping, while the remaining 21 (72.3%) initiated a protocol before knowing the lymphoma's immunophenotype. CHOP was the most commonly used chemotherapy protocol as first approach in over 90% of cases (n=27, 93.1%). The remaining protocols used as first approach were LOP (n=1, 3.4%) and a protocol consisting of lomustine, prednisone or prednisolone (LP) (n=1, Out of the 21 patients, only 3 (14.3%) underwent a protocol change after knowing the immunophenotype. Of these 3, 2 (66.6%) had a T immunophenotype, although the correlation was not statistically significant. A positive correlation was found between the immunophenotype and increased ionized calcium at the time of diagnosis, consistent with the literature. As of the date of this dissertation, there were no studies demonstrating a possible positive or negative impact of the immunophenotype on protocol changes, making this dissertation the first study on this topic. The sample size was the main limitation of this study, and despite not obtaining a positive correlation between immunophenotype and changes in the therapeutic protocol, this is a subject that requires further investigation. Without significant prospective studies evaluating alternative protocols in specific im munophenotypes, particularly T, immunophenotyping will continue to primarily serve as a prognostic tool in oncological development rather than a tool influencing treatment decisions. Key words: canine lymphoma; immunophenotyping; clinical outcome; therapeutic protocol; veterinary oncology.
Canine lymphoma is one of the most frequently diagnosed neoplastic diseases in dogs, being considered one of the three most common neoplasms in this species. Immunophenotyping is one of the diagnostic tools available to veterinarians. The immunophenotype of lymphoma, which can be B or T, is a strong prognostic factor, helping predict the clinica l development of the disease. Several studies have identified the T immunophenotype as the most aggressive, showing a lower response rate to chemotherapy, shorter re sponse duration, remission period, and survival compared to the B immunophenotype. This retrospective study aimed to investigate the influence of the immunophenotype on the choice of therapeutic protocol and clinical outcomes in dogs with canine lymphoma. The study, conducted using information collected from the ARHV, retrospectively analyzed twenty nine cases of dogs between January 2018 and June 2023 , with documented clinical history, a diagnosis of lymphoma, immunophenotyping testing performed , and a minimum of four chemotherapy sessions. A database was constructed with the collected d ata, and statistical analysis was performed. The majority of lymphomas were of the B immunophenotype (n=24, 82.8%), with the remaining cases (n=5, 17.2%) being of the T immunophenotype. Although not statistically significant, patients with B immunophenotype lymphoma had, on average, a longer survival time than those with T immunophenotype. Only 8 dogs (27.6%) started a chemotherapy protocol after immunophenotyping, while the remaining 21 (72.3%) initiated a protocol before knowing the lymphoma's immunophenotype. CHOP was the most commonly used chemotherapy protocol as first approach in over 90% of cases (n=27, 93.1%). The remaining protocols used as first approach were LOP (n=1, 3.4%) and a protocol consisting of lomustine, prednisone or prednisolone (LP) (n=1, Out of the 21 patients, only 3 (14.3%) underwent a protocol change after knowing the immunophenotype. Of these 3, 2 (66.6%) had a T immunophenotype, although the correlation was not statistically significant. A positive correlation was found between the immunophenotype and increased ionized calcium at the time of diagnosis, consistent with the literature. As of the date of this dissertation, there were no studies demonstrating a possible positive or negative impact of the immunophenotype on protocol changes, making this dissertation the first study on this topic. The sample size was the main limitation of this study, and despite not obtaining a positive correlation between immunophenotype and changes in the therapeutic protocol, this is a subject that requires further investigation. Without significant prospective studies evaluating alternative protocols in specific im munophenotypes, particularly T, immunophenotyping will continue to primarily serve as a prognostic tool in oncological development rather than a tool influencing treatment decisions. Key words: canine lymphoma; immunophenotyping; clinical outcome; therapeutic protocol; veterinary oncology.
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VETERINARY MEDICINE, DOGS, LYMPHOMA, IMMUNOPHENOTYPING, VETERINARY ONCOLOGY, CLINICAL PROTOCOLS, MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, MEDICINA VETERINÁRIA, CÃES, LINFOMA, IMUNOFENOTIPAGEM, ONCOLOGIA VETERINÁRIA, PROTOCOLOS CLÍNICOS, Mestrado Integrado em Medicina Veterinária