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B Cell CLL
07-08-2016, 05:04 PM,
B Cell CLL
My 11 year old Old English Sheepdog just started treatment for B Cell Chronic Lymphocytic Leukemia (CLL).  The oncologist was sure it was T Cell CLL and with treatment the prognosis was pretty good 1 to 3 years.  He says the B Cell is rare and prognosis is unknown.  She is being treated as if she has the T Cell.  Anyone out there with B Cell who can tell me what to expect?  Every day with her is cherished.    

Thank you in advance.
07-09-2016, 08:38 PM,
RE: B Cell CLL
Yep. My 13 yr old male Lab-mix 68 lbs was diagnosed early last Nov. I had noticed some of his jaw line lymph nodes swollen for a couple of months, waiting for them to explode like as would happen with lymphoma. Never really happened. Instead he started to wheeze, and at times make gagging sounds. Local vet thought it was collapsing trachea. At the point of diagnosis his WBC count was 212,000. Normal is 7.5K-15K. A "Flow Cytometric Immunophenotyping" from NC State confirmed it was B-CLL (e.g. >80% CD21+B5 B-cells, CD34 Neg). Before the Flow Cytometric results they gave him 10,000 IU of Elspar. Actually more useful against ALL.

The local Vet placed her bets on Lymphoma, the Oncologist on ALL, and I was leaning towards CLL due to its slow progression. Fortunately I won that bet.

He was immediately placed on 20 mg of Prednisone + 6 mg Leukeran due to the astronomical WBC count. Sometimes treatment is delayed if the WBC count is still low. I requested, and received antibiotics for the first 10 days of treatment to prevent any infections due to the tumor necrosis from the Chemo causing problems. If I remember correctly after 1 week the Leukeran was lowered to 3 mg, and the Prednisone to 15 mg. Subsequently the Prednisone was lowered to 10 mg, and then 0 mg. Within a couple of weeks after Prednisone was eliminated the cancer flared up. Most CLL dogs can get by with just the Leukeran, while others need Prednisone as a helper.

He was on 3 mg of Leukeran, plus 20 mg of Prednisone from Dec-Apr. During that time puppy wee-wees were frequent due to the Prednisone. His appetite soared, while gaining weight from 68-73 lbs. The only problems were excess panting, possibly due to the Prednisone, and also possibly due to a latent respiratory infection. Also during this time period he went on an organic food binge - eating deer berries in the woods. Normally not a problem for dogs, but it did cause severe diarrhea in his suppressed immune system.

First week of Apr he got a very severe sepsis infection (e.g. vomiting with a temp of 104.8). Be on the alert for infections! He was taken off the Leukeran, and kept on the Prednisone to help him fight off the infection. The cancer flared up without the Leukeran in 4 days (e.g. WBC count 13.5K --> 68K). Middle of April he raided the garbage, and ate a pile of plastic wrap. Hunger from the Prednisone. Another hospital visit where he emulated pancreatitis until he vomited up the plastic wrap a few hrs later at home. Last week of April another infection - this time I got him in very fast, and he was back to normal in 12 hrs. Be on alert for infections!!!

After April cut his Prednisone back to 10 mg. Currently on Leukeran 3 mg + Prednisone 10 mg. No more infections since April. His last WBC count was 16K, with most being neutrophils rather than the cancerous leucocytes. It took almost 7 months to achieve a complete remission, with the infections delaying things. His endurance is low, and he acts sluggish. However, overall he seems happy, and content. Currently on the floor next to me, barking in his sleep. Chasing something in his doggy dreams. He has graduated to once every 3 months for a CBC differential lab work, instead of once a month.

As you may have already found out CLL is caused by a cancerous WBC line that believes it should live forever. Refusing to undergo programmed cellular death. The result is a continuous build up in WBCs. These in turn can infiltrate the lining of the lung, spleen, and in worst case the bone marrow. Disrupting it's ability to produce RBCs. Mine was anemic, with a high platelet count at the point of diagnosis. He's now low normal for RBCs, and still a high platelet count.

I'm giving 2 supplements: Fish oil, and Vitamin-D. The Fish oil (Omega-3 fatty acids) normalizes Lactic acid, slightly anti-angiogenic, and slightly anti-infammatory. Also it interfers with clotting. So that might prevent clots due to the high platelet count. The Vitamin-D encourges the CLL cancer cells to... die! As in undergo programmed cellular death. In humans, trials have suggested 3+ months more of life. Goog it, especially with the Mayo clinic. I also give 50 mg of Benedryl at night. This dates back to pre-April when he seemed to have nasal congestion at night. If nothing else he likes eating the melted cheese balls containing the pills at night.

Diet is his usual of Nutro brand high endurance (30% protein, 15%(?) fat). Avoid all sugars - that promotes cancer growth. On the other paw, cancer cells have a hard time breaking down fats in the diet for nutrition. So my CLL puppy gets extra fat from the Sat steak snibbles left from my meal. His older sister, less fat.

Usually CLL progresses very slowly. Infection, and/or damage to the bone marrow always a danger. If the cancer becomes resistant to Leukeran, then another alkylating agent such as Cytoxan is tried. If the dog goes into complete remission, and stays in a complete remission for 1 yr, then sometimes all Chemo is stopped to see what happens. Life expectancy is 6 months to 3 yrs.
07-10-2016, 09:26 AM,
RE: B Cell CLL
Wow! Thank you sooooo much. It is more than the oncologist could tell me. Bree started her Prednisone and chemo chlorambucil on Friday. The Prednisone already has her drinking massive amounts of water and normal food is not enough. She stopped going on her daily walks just potties in the yard although if driven to the bark park she has a great time..if tiring a little bit early. She showed me she was ill with nose bleeds...so made her an early senior wellness appointment and the blood work showed CLL...so a month later we get to the Oncologist..the night before she had her second nose bleed. This week before starting the drugs she had 2 nose bleeds. I worry about the chemo as it says it can start bleeding disorders...I would call nose bleeds a disorder. My Vet pooh poohed that and said she probably wouldn't bleed out.

I did start her on fish and now I worry if it prevents clotting will she go chronic with the nose bleeds.

When I first got the news that she was anemic and probably had CLL I started her on 4 ox of cooked liver every day which will cute common anemia. To the oncologist her blood work showed less anemia with no drugs just liver!

"The Hunger" now has her in its grip. I am going to try a small meal before walkies to see if her mind will be less on getting back to food and more on normal dog activities.

Poor sweet girl has not had it easy. She is a rescue from a high kill shelter and was on death row because she was 8 years old and deaf. She was also nearly blind which I discovered a year ago..so for her 2nd adoption/birthday anniversary we went to an opthamologist. BLIND from cateracts. Blind and deaf..how scary for her. Got her eyes done and found out she didn't recognize me. Wasn't until she got close enough to smell that my velcro dog knew who I was. Now CLL...sweet Bree just can't get a break.

You have given me hope that perhaps she could go into remission and stay with me a long time. Every day with her is just the best.
07-10-2016, 12:41 PM,
RE: B Cell CLL
It sounds as though your CLL puppy-dog has too few platelets. Whereas mine is +20% above high end normal. In both dogs one has the CLL initially infiltrating the bone marrow, and interfering with its function. Besides the platelets, one has the RBC production altered resulting in anemia, or even immature RBCs unable to function well. Mine had a condition called Anisocytosis in early Dec, which later resolved itself. Goog it. The anemia or RBCs should come back to the normal range, as the leukeran+prednisone takes effect. With the Chemo the bone marrow will slowly recover, with the infiltrating cancer cells being cleared out. Dunno, bout the platelets, as it hasn't changed much for mine. But, it might for your dog. I insisted from the beginning that a copy of the lab work is Emailed to me. So I can correlate to what I'm seeing everyday in his behavior.

Large doses of fish oil could interfere with clotting. I'm giving mine 3000 mg for each of his 2 daily meals. Where I worry more about blood clots in his blood due to his excess platelets. You might want to only give 1000 mg/day, or wait until the platlets recover (i.e. normal count 170K-450K/ml). Ask the Oncologist for an opinion.

The initial high dose of Prednisone can cause anemia in some dogs. As the Oncologist reduces the dose of Prednisone, that may or may not help the anemia. Unless there is some complication like the spleen bleeding, the Leukeran should help the bone marrow, and RBCs to recover. But it may take literally months.

I use to take my two 13 yr olds on a 1 mile walk to the pond, and back. Now we're lucky to go 30 yards down the trail in the woods. When Leukemia dog comes back to walk by my side huffing and puffing. That's the body language signal telling me to turn around. A couple of times when I didn't respond, he turned around on his own, and walked back home. Rest of the day he veggies out, always ready to eat&drink. I don't push him. Currently the muggy summer temps he doesn't like too much.

The CLL does seem to have "chronic tiredness" as it's main clinical feature. Quite different than my prior dog's lymphoma. Where she had normal energy levels throughout her first remission of 9 months. Early in the remission a Cytoxan treatment caused her to bounce off the walls with energy. Not the usual thought the mention of Chemo conjures up. And other than the 1st week, and last 30 hrs, didn't have to worry about infections. Whereas infections seem a constant danger for CLL. Again, any sign of an infection (e.g. vomiting, fever), get the dog to an emergency hospital immediately. Infections can be life threatening very quickly for cancer puppies.

The only major things that can alter a long like span of a CLL dog are:

1. The Leukeran, and other Chemo drugs are not effective, almost at the beginning. Very rare. Chemo resistance in CLL usually takes a long time to develop. Where hopefully it's 2-3 yrs out for our dogs.

2. The cancer later progresses to what is called a "blast cell crisis". When it resembles the ALL form of Leukemia, and the dog suddenly becomes extremely ill with vomiting, fever, and diarrhea. A small chance of occurring, and difficult to treat.

3. Extremely rare, but reported in the literature is for the CLL to eventually transform into something that looks like Stage IV Lymphoma. Also extremely difficult to treat. See the Lymphoma thread for the discussion of early Prednisone inducing multiple drug resistance (MDR).

Our duty as doggy owners is to educate ourselves. So that we are aware of any problems as they occur, and not get blindsided by something unexpected. Just as important is to be able to ask the Oncologist the right questions, and understand their answers. It's a partnership.
07-10-2016, 02:54 PM,
RE: B Cell CLL
The Prednisone has her super active at home..hunting food and water...I let her body tell us how far a walkie will be. At the very beginning there was no change in her walkies then she started shortening them...then she would only walk a mile when her friends came by...lately she will stop one house away and turn back. So far if it is bark park day with her friends she is ready to go and leads the charge from the parking lot to the park, about a half mile.

I have been doing 1000 mg of fish oil every 3 days but I will check with the Vet to see what he thinks. No bloody nose since Thursday.

I had her given a Puppy cut at the groomer on Saturday..so strange to see her in a short cut but we are both ready should the drugs make her loose her hair. *smiles* Nekked Sheepdog on Steroids watch out cats!!
07-10-2016, 07:47 PM,
RE: B Cell CLL
(07-10-2016, 02:54 PM)Bellira Wrote: The Prednisone has her super active at home..hunting food and water...I let her body tell us how far a walkie will be. At the very beginning there was no change in her walkies then she started shortening them...then she would only walk a mile when her friends came by...lately she will stop one house away and turn back.  So far if it is bark park day with her friends she is ready to go and leads the charge from the parking lot to the park, about a half mile.  

I have been doing  1000 mg of fish oil every 3 days but I will check with the Vet to see what he thinks.  No bloody nose since Thursday.

I had her given a Puppy cut at the groomer on Saturday..so strange to see her in a short cut but we are both ready should the drugs make her loose her hair. *smiles*  Nekked Sheepdog on Steroids watch out cats!!

Most Chemo dogs don't loose their hair.  Only the ones who continuously shed heavily around the year.  Thus, Labs no.  Great Pyrenees yes.   My Leukemia dog is losing some on his hind legs.  Next time in I'll have him checked for Demodex mites (puppy mange) which can flare up in a suppressed immune system.  He had em when he was 8 weeks old.

A dose of fish oil 1000 mg every 3 days won't do anything be it good or bad.  Like I said I give mine 2-3000 mg doses.  Also take 3-3000 mg doses myself - elevates HDL cholesterol ( the good type) in humans.
07-11-2016, 12:30 PM,
RE: B Cell CLL
Thank you! I am learning so much! I actually took one of the fish oils just to see how my body would react. Don't worry I didn't do it with her perscribed meds. *giggles*

I am reading more and more about nutrition for cancer patients. I wonder why my oncologist never mentioned that sugar feeds cancer. I have always given her baby carrots as snacks and now know that is too much sugar. I am switching to brussell sprouts. I need to look for more veggies that would be good for her, broccoli?

Since she started the prednisone as well as The Hunger she doesn't sleep as much. I think this morning she hit a wall and got tired and slept a whole 4 hours. Needless to say I am not sleeping either. After two weeks the Prednisone goes from 30 mg to 20...I hope the hunger goes with it.

It is amazing how much I am learning everyday. Thank you again for taking the time for myself and Bree.
07-11-2016, 03:28 PM,
RE: B Cell CLL
" I actually took one of the fish oils just to see how my body would react. "

Potential side effects of too much fish oil are: scaly growths on the side of the neck resembling gills, and the desire to stay in the bath tub a lot.

The only veggie my current puppies will eat is potato, and pumpkin (e.g. good for helping them recover from diarrhea). They get their Nutro brand high endurance, as in high protein/fat. With my Leukemia dog getting +20% more in volume than before the cancer. As previously stated he has gained 5 lbs, and seems to be holding at that weight.

The only thing I noticed when the Prednisone was lowered from 20 mg to the current 10 mg, was less drinking, and a little less panting. Instead of having to let him out for puppy wee-wees every hr during the day, it's now every few hrs. The appetite stayed intact. He even tried to submarine his older sister, and get his nose to her dish, underneath her head, while she was trying to eat. It was comical to see, but she didn't think so (Grrrrr). I had to scold him, and tell him to leave his sister alone!

He's in the kitchen every night, waiting for something to "accidentally" fall to the floor.
07-14-2016, 09:25 AM,
RE: B Cell CLL
*giggles* I'll be joining the turtles in my pond soon! Right now I think Bree will eat anything!!!! She does seem to be getting used to the drugs. She seemed anxious with her hunger and thirst the first few days and now seems almost normal. The Prednisone is doing wonders for her arthritis much better than Rimodyl. She is walking faster and getting up quickly. She does two extra piddle runs now which is doable she had been waking me up several times a night.
07-14-2016, 01:28 PM,
RE: B Cell CLL
Make sure the kitchen garbage lid is on tight. In the middle of April mine was acting depressed, in pain (shivering). The emergency Vets couldn't find any evidence of infection. Brought him home after receiving pain shots, and he barfed up a pile of clear plastic wrap. It sort of mimicked a Pancreatitis attack.

Leukeran is at trace amounts in the saliva, and feces. But gets concentrated in the urine. If she does a puppy wee-wee in the house, you'll probably have to call the EPA, and report a toxic spill.

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