RETROSPECTIVE STUDIES

A Retrospective Study of Feline Gastric

Lymphoma in 16 Chemotherapy-Treated Cats
Tanya L. Gustafson, PhD, DVM*, Armando Villamil, PhD, DVM, Bonnie E. Taylor, DVMy, Andrea Flory, DVM, DACVIM
(Oncology)

ABSTRACT
The purposes of this study were to describe cases of feline gastric lymphoma with regards to signalment, clinical presentation,
laboratory and ancillary study findings, response to therapy, and outcomes and to identify prognostic variables. Sixteen cats
with stage I and II gastric lymphoma treated with chemotherapy were included in this study. Seventy-five percent of cats ex-
perienced remission. Overall, first remission duration was 108 days. Response to treatment was prognostic as in other types of
feline lymphoma. Cats with a complete remission (CR) had longer survival times compared with cats with a partial remission
(PR). Sex and treatment with a rescue protocol were found to be prognostic with castrated males having longer survivals than
spayed females. Cats that received rescue chemotherapy had shorter first remission durations than those that did not. Prior
treatment with steroids and stage were not found to be significant prognostic variables. This study characterizes gastric
lymphoma treated with chemotherapy in cats. Further studies are needed to determine the comparative efficacy of surgical
and chemotherapeutic treatments for feline gastric lymphoma. (J Am Anim Hosp Assoc 2014; 50:46–52. DOI 10.5326/JAAHA-
MS-5989)

Introduction mediastinal and leukemic forms tend to be T cell.5–7 Immuno-

Lymphoma is the most common neoplasm in cats, representing
1
30% of feline tumors. Lymphoma in cats is associated with
a bimodal age distribution, with a peak occurring at , 4 yr of age
2
and another occurring at 8 yr of age. Siamese cats and male cats
have also been associated with a higher risk of development of
3,4
lymphoma. Unlike canine lymphoma, which is typically mul-
ticentric involving peripheral lymph nodes, feline lymphoma has
a variety of anatomic and histologic presentations. Anatomically,
feline lymphoma may be mediastinal, gastrointestinal, nodal,
multicentric, or extranodal (with renal and nasal most common).
Histological classification involves immunophenotype (B cell or
T cell), cell size (large or small), and grade (high, intermediate, or
low). Renal and nasal forms are predominantly B cell, while
phenotype of gastrointestinal lymphoma is fairly evenly distrib-
uted between B cell and T cell, with 54–65% B cell.8–10 A recent
study, however, reports a majority of T-cell immunophenotype
(83%) in feline gastrointestinal lymphoma using antigen receptor
gene rearrangement analysis and immunohistochemistry, sug-
gesting that previous studies may have underestimated the inci-
dence due to difficulty in distinguishing mucosal T-cell lymphoma
from lymphoplasmacytic inflammatory bowel disease.11 Small
intestinal lymphoma has a slight predominance of T-cell pheno-
type (52%), whereas large intestinal lymphoma is comprised
mainly of B-cell disease (88%).10 Most feline lymphoma is clas-
sified as either intermediate- or high-grade.6,12 A large study
showed a higher prevalence of low-grade small cell phenotype in

From the Animal Cancer Care Clinic, Fort Lauderdale, FL (T.G., A.V.);
Department of Oncology, Veterinary Specialty Services, Manchester,
MO (B.T.); and Department of Oncology, Veterinary Specialty Hos-
pital, San Marcos, CA (A.F.).
Correspondence: tanya.gustafson@colostate.edu (T.G.)
AMC Animal Medical Center; CHOP cyclophosphamide, doxorubicin, vin-
cristine, and prednisolone; COP cyclophosphamide, vincristine, prednisone;
CR complete remission; PO per os; PR partial remission
*T. Gustafson’s present affiliation is Flint Animal Cancer Center, Colorado
State University, Fort Collins, CO.
†
B. Taylor’s updated credentials since article acceptance are DVM, DACVIM
(Oncology).

46 JAAHA | 50:1 Jan/Feb 2014 ª 2014 by American Animal Hospital Association


gastrointestinal lymphoma compared with a higher prevalence of
high-grade tumors in mediastinal lymphoma.12
Treatment of feline gastrointestinal lymphoma is variable with
protocols involving either oral prednisolone and chlorambucil or
a variety of multiagent chemotherapy protocols. The reported
median survival times for cats treated for lymphoma is 2–8
2,5,13–17
mo. Anatomic site plays a role in prognosis of feline lym-
phoma. In cats achieving a complete remission (CR), nasal lym-
phoma has a longer survival of 749 days, and central nervous
system lymphoma has a very short survival of 70 days.18 Also,
mediastinal and extranodal lymphoma has a significantly longer
remission duration compared with gastrointestinal lymphoma in
17
one study. Within gastrointestinal lymphoma, median survival
times vary widely from 2 mo to 24 mo and specific location has
19–24
not been shown to be prognostic. Across all studies, the most
consistent prognostic factor in feline lymphoma is response to
treatment. Survival times for cats with various anatomic forms of
lymphoma treated with the University of Wisconsin–Madison
chemotherapy protocol are 210 days overall, with a median of 654
days for cats achieving a complete response and 122 days for cats
16
with a partial response. In a study directly comparing low-grade
and high-grade gastrointestinal lymphoma, low-grade lymphoma,
as expected, has a better prognosis than high-grade, with a me-
dian survival of 17 mo for cats with low-grade lymphoma com-
pared with a median survival of 2.7 mo for cats with high-grade
lymphoma.21 Other prognostic factors classically used in canine
lymphoma, such as substage, immunophenotype, and pretreat-
ment with steroids, inconsistently predict outcome in feline
5,9,17,18
lymphoma. One study shows that substage is prognostic,
with a 9.5 mo survival for substage “a” cats and a 3.5 mo survival
for substage “b” cats; however, that classification is less useful in
cats with gastrointestinal lymphoma because almost all cats show
5
signs of illness. Steroid treatment prior to diagnosis does not
correlate with prognosis in most studies; however, in one study, if
CR is achieved, prior steroid treatment significantly reduces sur-
vival time.2,18
Gastric lymphoma is a relatively uncommon presentation of
feline lymphoma. A recent report found 24% of feline gastroin-
testinal lymphoma cases involved gastric tumors, but only 18%
were exclusively in the stomach, with a predominance of large
B-cell lymphoblastic lymphoma diagnosed.10 To the authors’
knowledge, there are no previous reports on the prognosis of
feline lymphoma confined to the stomach. The purposes of this
study are to describe cases of feline gastric lymphoma in regards
to signalment, clinical presentation, laboratory and ancillary study
findings, response to therapy, and outcomes and to identify
prognostic variables.
Study of Feline Gastric Lymphoma
Materials and Methods
Patient Selection and Evaluation
Medical records of all cats with a histologic or cytologic diagnosis
of gastric lymphoma at the Animal Medical Center, New York,
New York, between 2003 and 2007 and at the Animal Cancer Care
Clinic, Fort Lauderdale, Florida, between 2008 and 2010 were
reviewed. A total of 62 cases of feline lymphoma with stomach
involvement diagnosed either cytologically or histologically were
identified. Cats were excluded if there was evidence of lymphoma
in organs other than stomach and intra-abdominal lymph nodes
based on ultrasonographic appearance, endoscopic biopsy, or
surgical biopsy. Cases in which ultrasonographic appearance
suggested involvement of another organ, but histopathology was
also performed and did not support involvement of that organ,
were included. If ultrasonographic appearance suggested involve-
ment of another organ and either histopathology or cytology of
that organ was not performed, that cat was excluded. Twenty-
seven cases met the criteria. Cases were also excluded if they
did not receive chemotherapy. In total, 16 cats were included in
the study that had either cytologically or histologically diagnosed
lymphoma confined to the stomach and lymph nodes and were
treated with chemotherapy.
Signalment, historical, and physical examination findings
were recorded in all cases. Staging tests included complete blood
count, serum biochemical analysis, urinalysis, retroviral testing,
abdominal ultrasound, thoracic radiographs and, in few cases,
either bone marrow aspiration or immunophenotyping. No cats
were completely staged with all tests, but all cats had either an
abdominal ultrasound or exploratory laparotomy with biopsies.
Histologic grade, chemotherapy protocol, remission status, re-
mission duration, and survival time were recorded. The stage of
disease was determined based on the system reported in Mooney
et al. (1987), used at the Donaldson-Atwood Cancer Clinic.25
Chemotherapy
Chemotherapy protocols used included the following: 25 wk cy-
clophosphamide, doxorubicin, vincristine, and prednisolone
(CHOP); L-CHOP (i.e., the CHOP protocol with L-asparaginase
[400 IU/kg subcutaneously] given with or within 1 wk before the
first vincristine); cyclophosphamide, vincristine, prednisone (COP);
the Animal Medical Center (AMC) protocol; and chlorambucil
and prednisone. The chemotherapy agents used in the CHOP
protocol included vincristine (0.5–0.7 mg/m2 IV bolus), cyclo-
phosphamide (200 mg/m2 IV bolus), and doxorubicin (1 mg/kg
in 0.9% saline IV over 5–10 min). Steroid administration varied
with methylprednisolone (4 mg per os [PO] q 12 hr), either
prednisolone or prednisone (10 mg PO daily), and either
JAAHA.ORG 47
dexamethasone (0.8 mg subcutaneously q 24 hr) or methylpred-
nisolone acetate (20 mg intramuscularly once monthly). The COP
2
protocol alternated vincristine (0.5–0.7 mg/m IV) and cyclo-
phosphamide (200 mg/m2 IV). The AMC protocol used vincristine,
cyclophosphamide, and doxorubicin as above with long-term main-
tenance chemotherapy treatment with methotrexate (1 mg/kg IV q
fourth treatment) substituting for doxorubicin. In one cat, chlor-
ambucil (2 mg PO q 72 hr) was administered in combination with
prednisone (10 mg/cat PO q 24 hr).
Statistical Analysis
Remission duration was defined as the time from the date of
beginning treatment to either progression or recurrence of clinical
signs related to lymphoma. CR was defined as regression of all
clinical signs for at least 30 days. Partial remission (PR) was defined
as a . 50% but , 100% resolution of clinical signs for at least 30
days. No response was defined as either a , 50% resolution of
clinical signs or a response for , 30 days. Remission status was
determined by clinicians based on clinical signs reported by
owners and physical exam findings. Survival was defined as the
laboratory findings were also summarized in Table 1. A majority
of cats were in good body condition (50%), and a palpable ab-
dominal mass was only appreciated in five cats (31%). Abdominal
pain, as appreciated by the attending clinician at the time of
presentation, was present in two cats (13%), one of which was due
to septic peritonitis secondary to gastric perforation. Two cats
with thickened intestines on physical exam did not have intestinal
involvement based on abdominal ultrasound or surgical biopsy,
respectively. Anemia was a common laboratory finding, present in
eight cats (50%). Feline leukemia virus and feline immunodefi-
ciency virus testing was negative in all nine cats tested.
Ancillary studies included abdominal ultrasound, thoracic
radiographs, and in a few cases, a bone marrow aspirate. A bone
marrow aspirate was performed in only three cats, and in all cases
a normal aspirate was obtained. Thoracic radiographs were per-
formed in four cases, and were normal in all cases. Abdominal
ultrasonography was used in 12 cases. Abnormalities in the
TABLE 1

time from the date of histopathologic diagnosis of gastric lym- Characteristics of 16 Cats with Gastric Lymphoma Treated with
Combination Chemotherapy
phoma until death from any cause.
Descriptive data were subjected to a univariate analysis, and Category Variable n %
Clinical sign
median values were calculated for each of the variables. To evaluate
Vomiting 15 94
the prognostic significance of signalment (sex, age, and breed),
Diarrhea 2 13
clinical presentation (weight loss, anemia, inappetence, local versus Decreased appetite 8 50
diffuse disease, and vomiting), and specific treatment variables Lethargy 2 13
(clinical stage, tumor grade, chemotherapy protocol, rescue pro- Weight loss 9 56
tocol, pretreatment with steroid, and treatment response), Physical exam findings
Dehydration 7 44
a Kaplan-Meier method was performed with standard statistical
Poor body condition 6 38
softwarea. Values of P , 0.05 were considered significant.
Palpable abdominal mass 5 31
Abdominal pain 2 13
Results Cranial organomegaly 2 13
Sixteen cats with gastric lymphoma were identified for inclusion in Thickened intestines 2 13
this study based on retrospective search of either surgical biopsy or Laboratory test results
Anemia 8 50
necropsy reports in medical records. There were a variety of breeds
Thrombocytopenia 1 6
represented, including eight domestic shorthairs, three Oriental
Neutrophilia 8 50
breeds, two American shorthairs, one Turkish Van, one Ragdoll, Azotemia 0 0
and one Abyssinian. The mean and median ages were 11.4 yr and Elevated liver enzymes 1 6
12.8 yr (range, 4.6–16.1 yr), respectively. There were nine castrated FeLV/FIV status
males and seven spayed females. Negative 9 56
Positive 0 0
Clinical signs have been summarized in Table 1. Vomiting
Unknown 7 44
was the most common clinical sign, present in 94% of cats. That
Stage
was in contrast to previous reports for gastrointestinal lym- I 11 69
phoma, having weight loss as the most common presenting II 5 31
clinical sign.2,19,21,23,24 However, decreased appetite, weight loss,
FeLV, feline leukemia virus; FIV, feline immunodeficiency virus; n, number of
and lethargy were also common. Physical examination and cases.

48 JAAHA | 50:1 Jan/Feb 2014


stomach were observed in all 12 cases and varied from thickening
to a discernible mass. Eight cats (50%) had a mass detected on
ultrasound. One cat had ultrasonographic abnormalities observed
in the spleen that were determined to be nodular hyperplasia upon
biopsy. The same cat had ultrasonographic abnormalities observed
in the liver that were determined to be consistent with chol-
angiohepatitis on biopsy. Three cats (19%) had enlarged intra-
abdominal lymph nodes on abdominal ultrasound. These
lymph nodes were not biopsied because diagnosis was obtained
through endoscopy or cytology but were attributed to lymphoma.
Two additional cats were found to have lymph node involvement
on surgical biopsy. Endoscopy of the stomach was performed in
eight cats (50%), with masses visualized in the stomach of six of
those cases. Surgical biopsies were obtained in six cats (38%),
with masses visualized in five cases. Two cases were diagnosed by
cytology alone. Overall through either imaging or surgery, 81%
of cats were determined to have a stomach mass. Based on
those ancillary diagnostics, 11 cats were diagnosed with stage I
lymphoma, and 5 cats were diagnosed with stage II lymphoma
(Table 2).
Tumors were characterized histologically by grade in 14 cases.
High-grade tumors predominated (n ¼ 12), with the others being
graded as intermediate (n ¼ 2). Immunophenotype was only
performed in two cases, with the result of B-cell lymphoma.
The 16 cats included in the study were treated with combi-
nation chemotherapy. Two of those 16 cats underwent surgery
involving partial gastrectomy prior to chemotherapy treatment.
Combination chemotherapy consisted of the 25 wk CHOP pro-
tocol with L-asparaginase (n ¼ 11) or without L-asparaginase (n ¼
1), the AMC protocol with long-term maintenance chemotherapy
(n ¼ 2), the COP protocol (n ¼ 1), or chlorambucil and pred-
nisolone (n ¼ 1). Nine of the 16 cats treated with chemotherapy
achieved a CR and three obtained a PR, with an overall response
rate of 75%. Eight cats were treated with rescue protocols, in-
cluding mustargen, vincristine, prednisone, and procarbazine
(n ¼ 4); 1-(2-chloroethyl)3-cyclohexyl-1-nitrosurea (n ¼ 2); or
TABLE 2
Staging of Feline Gastric Lymphoma
Stage Description
I Either single tumor (extranodal) or single anatomic area (nodal)
II Single tumor (extranodal) with regional lymph node involvement
III Extensive unresectable intra-abdominal disease or two or more
nodal areas cranial and caudal to the diaphragm
IV Stages I–III with liver and spleen involvement
V Stages I–IV with initial involvement of central nervous system
and/or bone marrow
Study of Feline Gastric Lymphoma
L-asparaginase (n ¼ 2). Only two of those eight cats had a PR to
treatment (25%). The other six cats did not respond to rescue
therapy. Of the 16 cats treated with combination chemotherapy,
6 had received corticosteroids prior to diagnosis, including meth-
ylprednisolone (n ¼ 4), methylprednisolone acetate (n ¼ 1), and
an unrecorded type of steroid (n ¼ 1). Two of those cats had
previously been diagnosed with inflammatory bowel disease for
1 yr and 8 yr.
Median overall clinical remission duration was 108 days. In
cats achieving a PR, median remission duration was 125 days. In
cats achieving a CR, median remission duration was 189 days.
Median overall survival was 171 days. Median survival in cats
achieving only a PR was 138 days, significantly reduced compared
with those achieving a CR, with a median survival of 431 days (P ,
0.001). Cats that did not respond to treatment had a median
survival of 33 days (Figure 1).
In this small population, sex had a significant (P ¼ 0.049)
impact on survival time but not remission duration, with cas-
trated males having longer survival times (240 days) than spayed
females (109 days) as shown in Figure 2. Age, breed, body weight,
presenting clinical signs, and presence of anemia had no signifi-
cant impact on either remission duration or survival time in this
study. Pretreatment with steroids was not found to significantly
FIGURE 1 Overall survival for cats with gastric lymphoma
treated with chemotherapy based on response to therapy. Overall
survival was significantly different between cats that achieved
a complete remission (CR), a partial remission (PR), or no response
(NR) based on the log-rank test (P , 0.001).
JAAHA.ORG 49

FIGURE 2 Overall survival in cats with gastric lymphoma
treated with chemotherapy based on sex. Castrated males (M/C) had
significantly longer survival times than spayed females (F/S) (P ¼
0.049).
reduce either remission duration or overall survival (P ¼ 0.13;
Figure 3). There was also no difference between remission du-
ration and survival between cats with either stage I or stage II
FIGURE 3 Overall survival based on pretreatment with steroids
in cats with gastric lymphoma treated with chemotherapy. Difference
in survival is not significant (P ¼ 0.13).
50 JAAHA | 50:1 Jan/Feb 2014
lymphoma. Cats that did not receive rescue chemotherapy had
longer first remission durations compared with those that did
(P ¼ 0.019; Figure 4). Overall survival, however, was not signif-
icantly affected by rescue chemotherapy.
Discussion
Lymphoma in cats is a diverse disease. Although it is a systemic
disease, it localizes to a variety of organs in cats. This study sought
to describe cases of lymphoma localized to the stomach in cats, in
regards to signalment, clinical presentation, laboratory and an-
cillary study findings, response to therapy, and prognostic vari-
ables. The median age of cats with gastric lymphoma was 12.8 yr,
similar to previous reports of gastrointestinal lymphoma.2,5,21–24
Vomiting was the most common clinical sign reported in this
study, in contrast to most reports of feline gastrointestinal lym-
phoma in which weight loss was more common.2,19,21,23,24 Lym-
phoma of the gastrointestinal tract can present as either diffuse
infiltration or a discrete mass. In this study of primary gastric
lymphoma, 81% of cats had a mass present. Eight cats (50%) had
endoscopic biopsies to confirm lymphoma, and endoscopy has
FIGURE 4 First remission duration based on rescue chemotherapy
protocol in cats with gastric lymphoma treated with chemotherapy.
Rescue protocols included mustargen, vincristine, prednisone, and
procarbazine (MOPP); 1-(2-chloroethyl)3-cyclohexyl-1-nitrosurea
(CCNU); or L-asparaginase (L-aspar) alone. Cats that did not
receive rescue chemotherapy had significantly longer remission
durations compared with cats that did receive rescue chemotherapy
(P ¼ 0.019).

previously been shown to be adequate for diagnosis of gastric
lymphoma. Involvement of other organs was based on ultrasound
examination in the eight cases biopsied endoscopically in this
study.26 Therefore, there was the possibility of inclusion of cases
with more extensive abdominal involvement of lymphoma in
organs that were not biopsied in this study. Previous reports have
shown a predominance of high-grade lymphoma arising in the
stomach, and that was supported in this study, with 75% iden-
10,21
tified as high-grade and 12% identified as intermediate-grade.
No low-grade tumors were identified.
Cats in this study received either multiagent chemotherapy
(i.e., CHOP, L-CHOP, COP, or the AMC protocol) or oral che-
motherapy (chlorambucil and prednisolone). The overall re-
sponse rate was 75%. The overall median CR duration was 108
days, and overall survival was 171 days. Those remission and
survival times of cats with gastric lymphoma were comparable to
16,19–24
those in previous reports of high-grade feline lymphoma.
Although a chlorambucil and prednisolone protocol is not typi-
cally used in the treatment of high-grade lymphoma, the one cat
receiving that protocol in this study did so due to owner prefer-
ence. That cat had a CR to treatment for 86 days and an overall
survival time of 103 days. In this study, sex was found to signif-
icantly affect overall survival time, with castrated males having
a more favorable prognosis than spayed females. Due to small
sample size of this study, that finding may not be clinically rele-
vant. None of the cats in this study were intact. In fact, no intact
cats were present in the original 62 cats identified with gastro-
intestinal lymphoma involving the stomach. That was consistent
with a recent epidemiologic study on feline intestinal neoplasia
that showed a decreased risk in intact animals.27 It was possible
that increased age played a role in an increased likelihood of
neutered status; however, further investigation of a protective
effect in intact felines is warranted. Treatment with a rescue
protocol was found to be negatively associated with first remission
duration in the cats in this study. Due to small sample size and
heterogeneity of treatment, many confounding variables could
have affected that finding. However, it is possible the cats that
responded well to first-line chemotherapy for a prolonged time
period were less likely to be treated with rescue protocols. That
may be due to owner satisfaction with initial treatment outcome,
financial reasons after prolonged treatment, a sudden clinical
decline upon relapse, or death due to another cause. Counterin-
tuitively, the majority of cats treated with a rescue protocol had
achieved remission with first-line therapy, with four of eight cats
(50%) achieving CR and two of eight cats (25%) achieving PR.
Stage and pretreatment with steroids did not significantly affect
either remission duration or survival in the cats studied. The
Study of Feline Gastric Lymphoma
authors acknowledge that such an analysis was underpowered,
and the lack of a significant difference cannot be ruled out due to
the small sample size. Previously, pretreatment with steroids has
been shown to reduce survival times in cats obtaining a CR.18 In
this study, only two cats achieving a CR received pretreatment
steroids, limiting interpretation of the effect in this population.
Response to therapy was significantly associated with both re-
mission duration and overall survival in this study, consistent with
previous studies.16 Survival times in those cats achieving CRs and
PRs in this study were very similar to those reported by Milner
et al. (2005), suggesting that stomach anatomic location is not
a significant negative prognostic factor in feline lymphoma.16
Only two cats were treated with surgical excision of their gastric
lymphoma with incomplete margins in both cases. Therefore,
meaningful conclusions about the benefit of surgery in feline
gastric lymphoma cannot be drawn from this study. However, in
human patients with gastric and intestinal non-Hodgkin’s lym-
phoma, surgery improves overall survival.28,29 Further prospective
studies evaluating surgery in the treatment of feline gastric lym-
phoma are needed.
Shortcomings of this study included the lack of complete
staging, including immunophenotyping, in many of the cats and
the reliance of clinicians on clinical signs to signify remission. The
small number of cases in this study may hinder the value of the
statistical analysis. Due to the limited sample size, a type I error
cannot be ruled out for the differences in outcomes associated with
sex, response to therapy, and rescue protocol. There was also
inconsistency in treatment of the cats in this study, and, due to low
numbers receiving individual protocols, direct comparisons could
not be made. Those limitations, however, are unfortunately in-
herent in a retrospective study. Even with those limitations, this
study supports that cats with gastric lymphoma have a similar
prognosis to cats with other forms of high-grade gastrointestinal
lymphoma and that response to treatment is seen in approximately
75% of cats with gastric lymphoma.
This study supports the fact that future studies to investigate
the benefit of surgery in treatment of feline gastric lymphoma and
the hormonal impact on the risk and response to treatment in
feline gastric lymphoma are warranted. Additionally, prospective
studies to identify a more favorable chemotherapy protocol, either
first-line or rescue, based on remission duration and associated
toxicities are very much needed for this disease.
Conclusion
The results of this retrospective study indicate that cats diagnosed
with gastric lymphoma can experience survivals comparable with
other types of feline lymphoma with chemotherapy treatment.
JAAHA.ORG 51
These results show that response to therapy, sex, and rescue
chemotherapy treatment had prognostic value. Further compar-
ative prospective studies are needed to evaluate the most effective
surgical and chemotherapeutic approach to the treatment of high-
grade feline gastric lymphoma.
FOOTNOTES
a
SigmaPlot 11.0 Software; Systat Software Inc., San Jose, CA
REFERENCES
1. Dorn CR, Taylor DO, Hibbard HH. Epizootiologic characteristics of
canine and feline leukemia and lymphoma. Am J Vet Res 1967;28
(125):993–1001.
2. Grover S. Gastrointestinal lymphoma in cats. Comp Cont Educ Pract
2005;27(10):741–51.
3. Court EA, Watson ADJ, Peaston AE. Retrospective study of 60 cases
of feline lymphosarcoma. Aust Vet J 1997;75(6):424–7.
4. Gabor LJ, Malik R, Canfield PJ. Clinical and anatomical features of
lymphosarcoma in 118 cats. Aust Vet J 1998;76(11):725–32.
5. Vail DM, Moore AS, Ogilvie GK, et al. Feline lymphoma (145 cases):
proliferation indices, cluster of differentiation 3 immunoreactivity,
and their association with prognosis in 90 cats. J Vet Intern Med
1998;12(5):349–54.
6. Gabor LJ, Canfield PJ, Malik R. Immunophenotypic and histological
characterisation of 109 cases of feline lymphosarcoma. Aust Vet J
1999;77(7):436–41.
7. Day MJ, Henderson SM, Belshaw Z, et al. An immunohistochemical
investigation of 18 cases of feline nasal lymphoma. J Comp Pathol
2004;130(2–3):152–61.
8. Jackson ML, Wood SL, Misra V, et al. Immunohistochemical
identification of B and T lymphocytes in formalin-fixed, paraffin-
embedded feline lymphosarcomas: relation to feline leukemia virus
status, tumor site, and patient age. Can J Vet Res 1996;60(3):199–204.
9. Patterson-Kane JC, Kugler BP, Francis K. The possible prognostic
significance of immunophenotype in feline alimentary lymphoma:
a pilot study. J Comp Pathol 2004;130(2–3):220–2.
10. Pohlman LM, Higginbotham ML, Welles EG, et al. Immunophe-
notypic and histologic classification of 50 cases of feline gastroin-
testinal lymphoma. Vet Pathol 2009;46(2):259–68.
11. Moore PF, Rodriguez-Bertos A, Kass PH. Feline gastrointestinal
lymphoma: mucosal architecture, immunophenotype, and molec-
ular clonality. Vet Pathol 2012;49(4):658–68.
12. Valli VE, Jacobs RM, Norris A, et al. The histologic classification of
602 cases of feline lymphoproliferative disease using the National
Cancer Institute working formulation. J Vet Diagn Invest 2000;12(4):
295–306.
13. Cotter SM. Treatment of lymphoma and leukemia with cyclo-
phosphamide, vincristine, and prednisone, II, treatment of cats.
J Am Animal Hosp Assoc 1983;19:166–72.
52 JAAHA | 50:1 Jan/Feb 2014
14. Jeglum KA, Whereat A, Young K. Chemotherapy of lymphoma in 75
cats. J Am Vet Med Assoc 1987;190(2):174–8.
15. Teske E, van Straten G, van Noort R, et al. Chemotherapy with
cyclophosphamide, vincristine, and prednisolone (COP) in cats
with malignant lymphoma: new results with an old protocol. J Vet
Intern Med 2002;16(2):179–86.
16. Milner RJ, Peyton J, Cooke K, et al. Response rates and survival
times for cats with lymphoma treated with the University of
Wisconsin-Madison chemotherapy protocol: 38 cases (1996–2003).
J Am Vet Med Assoc 2005;227(7):1118–22.
17. Simon D, Eberle N, Laacke-Singer L, et al. Combination
chemotherapy in feline lymphoma: treatment outcome, tolera-
bility, and duration in 23 cats. J Vet Intern Med 2008;22(2):394–
400.
18. Taylor SS, Goodfellow MR, Browne WJ, et al. Feline extranodal
lymphoma: response to chemotherapy and survival in 110 cats.
J Small Anim Pract 2009;50(11):584–92.
19. Mahony OM, Moore AS, Cotter SM, et al. Alimentary lymphoma
in cats: 28 cases (1988–1993). J Am Vet Med Assoc 1995;207(12):
1593–8.
20. Zwahlen CH, Lucroy MD, Kraegel SA, et al. Results of chemother-
apy for cats with alimentary malignant lymphoma: 21 cases (1993–
1997). J Am Vet Med Assoc 1998;213(8):1144–9.
21. Fondacaro JV, Richter KP, Carpenter JL, et al. Feline gastrointestinal
lymphoma: 67 cases (1988–1996). Eur J Comp Gastroenterol 1999;4:
5–11.
22. Carreras JK, Goldschmidt M, Lamb M, et al. Feline epitheliotropic
intestinal malignant lymphoma: 10 cases (1997–2000). J Vet Intern
Med 2003;17(3):326–31.
23. Kiselow MA, Rassnick KM, McDonough SP, et al. Outcome of cats
with low-grade lymphocytic lymphoma: 41 cases (1995–2005). J Am
Vet Med Assoc 2008;232(3):405–10.
24. Lingard AE, Briscoe K, Beatty JA, et al. Low-grade alimentary
lymphoma: clinicopathological findings and response to treatment
in 17 cases. J Feline Med Surg 2009;11(8):692–700.
25. Mooney SC, Hayes AA, Matus RE, et al. Renal lymphoma in cats: 28
cases (1977–1984). J Am Vet Med Assoc 1987;191(11):1473–7.
26. Evans SE, Bonczynski JJ, Broussard JD, et al. Comparison of en-
doscopic and full-thickness biopsy specimens for diagnosis of in-
flammatory bowel disease and alimentary tract lymphoma in cats.
J Am Vet Med Assoc 2006;229(9):1447–50.
27. Rissetto K, Villamil JA, Selting KA, et al. Recent trends in feline
intestinal neoplasia: an epidemiologic study of 1,129 cases in the
veterinary medical database from 1964 to 2004. J Am Anim Hosp
Assoc 2011;47(1):28–36.
28. Ouakaa-Kchaou A, Gargouri D, Elloumi H, et al. Survie des patients
atteints de lymphome gastrique [Survival in patients with gastric
lymphoma]. Tunis Med 2011;89(10):752–7 [in French].
29. Kim SJ, Choi CW, Mun YC, et al. Multicenter retrospective analysis
of 581 patients with primary intestinal non-hodgkin lymphoma
from the Consortium for Improving Survival of Lymphoma (CISL).
BMC Cancer 2011;11:321.