C10027083 / invoice 10000

Week 1: (6/3/26) CBC (Vetnostics) - Hct 0.37; Neu 3.9x10^9/L; Plt 36k/uL; no circulating atypical cells Biochem^ - within normal limits Maropitant 80mg PO Epirubicin [2mg/mL] 30mg/m2 = 36mg = 18mL slow IV Prednisolone 40mg/m2 or 50mg (20mg, 2.5 tab) PO eod Week 2: CBC1 Week 3: CBC2 Biochem Temozolomide Week 4: CBC1 Week 5: CBC2 Biochem^ CCNU Week 7: CBC2 Biochem^ EPI CHLORAM Week 8: CBC1 Week 9#: CBC2 Temozolomide Week 11: CBC2 Biochem^ CCNU Week 13: CBC2 Biochem^ EPI CHLORAM Week 15: back to week 3 and repeat week 3-13 then contact VOC Temozolomide 100 mg/m2 PO daily for 5 consecutive days Give maropitant 1 hour before each dose. PRED = Prednisolone 40 mg/m2 every alternate day throughout EPI = Epirubicin 30 mg/m2 IV CHLORAM = Chlorambucil 4 mg/m2 PO daily for 10 days starting the day after epirubicin CCNU = Lomustine 60mg/m2 PO once + Denamarin SID for 14 days 1. If neutrophil count < 1.0 x 109/L give prophylactic antibiotics and monitor for sepsis. Reduce future dosage of Temozolomide OR Epirubicin OR CCNU by 20%. 2.If neutrophil count is <2.0 x109/L or if platelets <100 x 109/L at time treatment is due, postpone therapy until counts normalize. Reduce future dosage of the previous drug(s) by 10%. ^ If ALT >3x upper limit of normal contact VOC prior to administering chemotherapy as dose adjustment may be required # assess remission, if a partial response has not been obtained by this point contact VOC for advice Note the doses in this protocol are for Magyver on 5 March 2026 and may not be appropriate for other animals. © Copyright Veterinary Oncology Consultants, Pty Ltd.    Vital Signs    

History: Recheck CBC 1-week post Epirubicin chemotherapy for re-relapsed lymphoma B-cell lymphoma Initial CHOP chemotherapy for B-cell lymphoma completed July 2025, relapse 26/11/25 CHOP recommenced and the patient underwent HBRT Patient developed Grade 2 neutropenia and Grade 4 thrombocytopenia post radiotherapy The neutropenia had resolved but the thrombocytopenia is ongoing OCC recommends proceeding with chemotherapy as long as there is no active bruising/petichial lesions and the WCC is adequate Re-relapse detected 27/3/26 See previous histories for details Current medications: 1) Prednisolone 40mg/m2 or 50mg (20mg, 2.5 tab) PO eodExamination: (update)Neurological Mentation: BAR Gait: Ambulatory, no weakness or ataxia Cardiovascular HR: 100bpm MMs: Pink, moist CRT: 1.5s Pulses: Normal and synchronous Auscultation: No murmur or arrhythmias Respiratory Rate: 24brpm Effort: Normal Pattern: Costoabdominal Auscultation: Normal bronchovescicular sounds Abdominal palpation: Comfortable, no obvious masses Temperature: 38.3C No petechiation or ecchymoses The Lt and Rt submandibular and pre-scapular Lns are approximately 3cm in diameter, the Rt submanidbular Ln palpates semi-firmly The Lt and Rt popliteal Lns are approximately 2cm in diameter, palpates firmly The axillary and inguinal Lns are not palpable Laboratory: CBC - Hct %; Neu x10^9/L; Plt k/uL Assessment: Plan: 1) Vetnostics CBC (VFB) pending 2) Back in 1-week for continuation of chemotherapyCurrent medications: 1) Prednisolone 40mg/m2 or 50mg (20mg, 2.5 tab) PO eod    Vital Signs