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This forum was created as a support group for owners of dogs with GME (Granulomatous Meningoencephalomyelitis) or NME (Necrotizing Meningoencephalitis). The board is a place to share whatever you want with others who know what you are going through.
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 Post subject: Cytosar dosing
PostPosted: Fri Nov 12, 2010 10:42 pm 
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Just wondering what doses of cytosar are being given (mg/m2 or mg's given & weight of dog). Has anyone tried varying doses to monitor response?

We have tried several doses and # of injections with a varied response. The last time we used a dose which caused significant mylosuppression, and I have not given it since. However, I am thinking it might be worth a try again-I am seeing some neurological decline and it may be an option-at a lower dose.

I am hoping I can get some imput on what others are using with success.

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Susan & Cubbie 7yr old G Ret.
Tiger GME diagnoised June 08 Peacefully waiting at the Rainbow Bridge May 2011


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 Post subject: Re: Cytosar dosing
PostPosted: Sat Nov 13, 2010 3:50 am 
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Magic currently weighs 12.65kg but has been over 13kg, ever since she was diagnosed she has been having 4 doses of 0.25ml at each round of treatment.

The neuro and my vet worked out the dose based on a m2 calculation, which quite honestly makes my brain hurt so I have to trust their maths skills.

Hope this helps, let me know if changing the dose works, If the MM doesn't work I may have to think about increasing Magic's dose.

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Em
Magic,
Born Aug 2004,
Diagnosed 14 May 2009
Gone to the Rainbow Bridge 22nd Dec 2010


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 Post subject: Re: Cytosar dosing
PostPosted: Sat Nov 13, 2010 9:02 am 
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Boy is 10 kg and he gets 2.3 mls twice a day for two days a month. That was the first dose we tried, and based on Boy's post-cytosar CBC, Sisson said it was the correct dose. Isn't everyone's vet adjusting the dose based on the post-cytosar CBC that first time? I thought they used guidelines, but since it can vary, that's why the CBC is checked after the injections the first time to double check it's the right dose for a particular dog?

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Boy: 11 yo 22 lb rat terrier extraordinaire
3/10: Cyclosporine (CyA), zonisamide
7/10: CyA, pred, leflunomide, cytosar, lomustine, keppra, clavamox
6/11: Stopped chemo
2/12: Stopped leflunomide; 3/12 CyA every 2 days
4/12: Relapse; treatment


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 Post subject: Re: Cytosar dosing
PostPosted: Sat Nov 13, 2010 9:31 am 
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Hi Susan,

Nelly started Cytarabine at 20 mg for each injection (suspension was 100mg/5mL). She was about 15 lbs at the time.

When we had added lomustine and leflunomide, they changed her dosage based on her pre-cytarabine CBC and other considerations (like high WBC count and possible infection). So her last round was 17 mg for each injection (same suspension) and she was about 13 lbs.

Hope it works out for Tiger :D

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Crystal
Nelly, Pug, born 4/15/01, 13-15 lbs, dx PDE/NME 2/17/04, transitioned 11/28/09, confirmed dx at necropsy
http://nellygme.wordpress.com


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 Post subject: Re: Cytosar dosing
PostPosted: Sat Nov 13, 2010 6:40 pm 
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Thanks for the response.

Em & Gillian do you know what concentration (mg/ml) the cytosar is or how many mg's you are giving.

Crystal you were giving about 55mg/m2 did you see an improvement that correlated to when you gave the cytosar?

We have tried 60mg/m2, 80mg/m2 and 100mg/m2 at both 4 injections and 6 injection and have seen varied response. We will not repeat the 100mg/m2 X 6 inj due to the mylosurppression and thrombcytopenia.

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Susan & Cubbie 7yr old G Ret.
Tiger GME diagnoised June 08 Peacefully waiting at the Rainbow Bridge May 2011


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 Post subject: Re: Cytosar dosing
PostPosted: Sun Nov 14, 2010 9:58 am 
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Hi Susan,

To be perfectly honest, I did not see any improvement with that dose and wondered if it was doing anything at all. And then we stopped it. And she got worse. So obviously it was doing something... Maybe it was just holding her there, though.

Wish I could be more helpful :(

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Nelly, Pug, born 4/15/01, 13-15 lbs, dx PDE/NME 2/17/04, transitioned 11/28/09, confirmed dx at necropsy
http://nellygme.wordpress.com


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 Post subject: Re: Cytosar dosing
PostPosted: Sun Nov 14, 2010 2:48 pm 
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From the introductory materials I got from the GME Sisson-happy forum, "Dr. Sisson has also revised the dosing protocol for Cytarabine. He no longer uses the 150 mg/m2 dose. He starts and stays with 100 mg/m2 x 4 doses over 48 hours unless a dog's blood work shows declines and then he reduces the dose toward the end of the first year to 50 mg/m2 x 4 over 48 hours."

I just looked and Boy is getting 46 mg (he weighs 10 kg). Two injections a day for two days a month, but Boy is also on lomustine two weeks after the cytarabine. I'll post back with the concentration later when I can get a look at the bottles. I hope that helps!

As for response, the funny thing is that the only thing I really noticed, was that Boy's skin seemed much less inflamed a couple of days after the cytarabine injections (at the time when he first started it he was still manifesting skin allergies). Neurologically, he has relapsed while on cytarabine, but I'd be interested in perhaps looking up when those occurred and see if they were the week before the next cytarabine dose. Then again, he had complicating factors like nocardia infections that seemed to set things off twice. And I did think that those were coming back at the cytarabine nadirs when his immune system was the most suppressed - before we upped the clavamox again. So, Boy might not be a good example to track that. I actually think that lomustine (which crosses the CNS barrier) seems to be more effective than cytarabine, but I'm sure it's doing something too.

How is Tiger doing? I'm sorry the MM isn't keeping things in check anymore. Do you think he might have an infection?

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Boy: 11 yo 22 lb rat terrier extraordinaire
3/10: Cyclosporine (CyA), zonisamide
7/10: CyA, pred, leflunomide, cytosar, lomustine, keppra, clavamox
6/11: Stopped chemo
2/12: Stopped leflunomide; 3/12 CyA every 2 days
4/12: Relapse; treatment


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 Post subject: Re: Cytosar dosing
PostPosted: Sun Nov 14, 2010 4:22 pm 
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The concentration is 100 mg/5 ml. Boy gets 2.3 ml in each of the four injections (about 46 mg). Sorry it took me so long to get that info together - I didn't have his meds with me, and I couldn't find it all in my emails from Dr. Sisson. I hope Tiger's been doing better!

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Boy: 11 yo 22 lb rat terrier extraordinaire
3/10: Cyclosporine (CyA), zonisamide
7/10: CyA, pred, leflunomide, cytosar, lomustine, keppra, clavamox
6/11: Stopped chemo
2/12: Stopped leflunomide; 3/12 CyA every 2 days
4/12: Relapse; treatment


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 Post subject: Re: Cytosar dosing
PostPosted: Sun Nov 14, 2010 6:02 pm 
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Thanks Crystal & Gillian,

So Boy is on a titch under 100mg/m2(he is .47 m2). Interesting that both of you feel that there isn't a significant improvement but when they don't get it they relapse-hmmm.

Tiger has started to show some neuro signs-drooling and propreceptive deficts all limbs-We have been very fortunate since April he has been symptom free-with the help of mm. But unfortunately we have exhausted our options and I am not even sure if a low dose of cytosar is an option. We have an appt with our neuro on Wed.-wee'll see...

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Susan & Cubbie 7yr old G Ret.
Tiger GME diagnoised June 08 Peacefully waiting at the Rainbow Bridge May 2011


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 Post subject: Re: Cytosar dosing
PostPosted: Sun Nov 14, 2010 6:11 pm 
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I'm so sorry to hear that! I apologize - I can't recall all of the meds Tiger has already tried, but I think you'd said he'd had a problem with most of the others? I.e., lomustine and leflunamide are out too? I would think that using cytarabine might help. But to be honest, my first concern would be double checking for any possible infection. Has he had a CBC recently? What was the WBC count? Otherwise, has anything changed recently? It seems odd that he was doing so great and so stable, and just now having problems. Has he ever been allergic to anything?

Boy is just now looking like his foot proprioception is getting worse too, and lo and behold, he's due for cytarabine in three and a half days. I'll let you know if I can actually see the improvement since I'll be with him for a couple of weeks. Probably would have been a good idea to document everything to begin with. Argh.

I hope your neuro/vet have some good ideas to ferret out what's going on or things to try. Please post back and let us know.

Fingers and paws crossed for improvement,

Gillian & Boy

_________________
Boy: 11 yo 22 lb rat terrier extraordinaire
3/10: Cyclosporine (CyA), zonisamide
7/10: CyA, pred, leflunomide, cytosar, lomustine, keppra, clavamox
6/11: Stopped chemo
2/12: Stopped leflunomide; 3/12 CyA every 2 days
4/12: Relapse; treatment


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