Chemotherapy protocols for lymphoma: ferrets

Chemotherapy protocols for lymphoma: ferrets

Note: the suggested protocols are based on clinical application and case studies and extrapolated from other species; there are no primary controlled trials in ferrets. A CBC should be performed prior to the administration of any chemotherapeutic agents.

Option 1

Week	Day	Drug	Dose and route
1	1	Prednisolone	1–2 mg/kg p.o. q12h continued throughout course of therapy
	1	Vincristine	0.025 mg/kg i.v.
	3	Cyclophosphamide	10 mg/kg p.o., s.c.
2	8	Vincristine	0.025 mg/kg i.v.
3	15	Vincristine	0.025 mg/kg i.v.
4	22	Vincristine	0.025 mg/kg i.v.
4	24	Cyclophosphamide	10 mg/kg p.o., s.c.
7	46	Cyclophosphamide	10 mg/kg p.o., s.c.
9	63	Prednisolone	Taper dose down gradually to 0 over the next 4 wks

Option 2

Week	Drug	Dose and route
1	Vincristine	0.025 mg/kg i.v.
	Asparginase a	400 IU/kg i.p.
	Prednisolone	1 mg/kg p.o. q24h continued throughout course of therapy
2	Cyclophosphamide	10 mg/kg p.o., s.c.
3	Doxorubicin	1 mg/kg i.v.
4	Vincristine	0.025 mg/kg i.v.
5	Cyclophosphamide	10 mg/kg p.o., s.c.
6	Doxorubicin	1 mg/kg i.v.
8	Vincristine	0.025 mg/kg i.v.
10	Cyclophosphamide	10 mg/kg p.o., s.c.
12	Vincristine	0.025 mg/kg i.v.
14	Methotrexate	0.5 mg/kg i.v.

a Premedicate with diphenhydramine at 1-2 mg/kg i.m. 30 minutes prior to administration to prevent an anaphylactic response.

Option 3

Week	Drug	Dose and route
−3	Asparginase a	400 IU/kg s.c.
1	Vincristine	0.12 mg/kg i.v.
	Prednisolone	1 mg/kg p.o. q24h continued throughout course of therapy
	Cyclophosphamide	10 mg/kg p.o.
2	Vincristine	0.12 mg/kg i.v.
3	Vincristine	0.12 mg/kg i.v.
4, 7, 10, 13, etc. (q3wks)	Vincristine	0.12 mg/kg i.v.
	Cyclophosphamide	10 mg/kg p.o.
Rescue	Doxorubicin a	1–2 mg/kg i.v. slow infusion

a Premedicate with diphenhydramine at 1-2 mg/kg i.m., s.c. 30 minutes prior to administration to prevent an anaphylactic response.

Option 4 (avoiding i.v. route)

Week	DRUG	Dose and route
1	Asparginase a	10,000 IU/m2 s.c.
	Cyclophosphamide	250 mg/m2 p.o., s.c. (in 50 ml/kg NaCl s.c.)
	Prednisolone	2 mg/kg p.o. q24h for 7 days then q48h throughout course of therapy
2	Asparginase a	10,000 IU/m2 s.c.
3	Asparginase a	10,000 IU/m2 s.c.
3	Cytosine arabinoside	300 mg/m2 s.c. q24h for 2 days (dilute 100 mg in 1 ml sterile water)
4	Asparginase a	10,000 IU/m2 s.c.
5	Cyclophosphamide	250 mg/m2 p.o., s.c. (in 50 ml/kg NaCl)
7	Methotrexate	0.8 mg/kg i.m.
9	Cyclophosphamide	250 mg/m2 p.o., s.c. (in 50 ml/kg NaCl)
11	Cytosine arabinoside	300 mg/m2 s.c. q24h for 2 days (dilute 100 mg in 1 ml sterile water)
11	Chlorambucil	2mg tablet/ferret p.o.
13	Cyclophosphamide	250 mg/m2 p.o., s.c. (in 50 ml/kg NaCl)
15	Procarbazine	50 mg/m2 p.o. q24h for 14 days
18	Cyclophosphamide	250 mg/m2 p.o., s.c. (in 50 ml/kg NaCl)
20	Cytosine arabinoside	300 mg/m2 s.c. q24h for 2 days (dilute 100 mg in 1 ml sterile water)
23	Cyclophosphamide	250 mg/m2 p.o., s.c. (in 50 ml/kg NaCl)
26	Procarbazine	50 mg/m2 p.o. q24h for 14 days
28	Repeat weeks 20–26 if not in remission for 3 cycles

Note: perform a CBC at weeks 2, 4, 7, 8, 12, 16, 17 and 27; if severe myelosuppression, reduce dose by 25% for subsequent treatments of the previously used drug.

a Premedicate with diphenhydramine at 1–2 mg/kg i.m., s.c. 30 minutes prior to administration to prevent an anaphylactic response.

References

Antinoff N and Hahn K (2004) Ferret oncology: diseases, diagnostics and therapeutics. Veterinary Clinics of North America: Exotic Animal Practice 7, 579–625

Webb JK, Graham JE, Burgess KE and Antinoff N (2019) Presentation and survival time of domestic ferrets ( Mustela putorius furo ) with lymphoma treated with single-and multi-agent protocols: 44 cases (1998-2016). Journal of Exotic Pet Medicine 31, 64–67