I've got a case that I'd like to start CCNU in, but I've never actually used CCNU before. It's a chocolate lab that's been diagnosed on cytology with histiocytic sarcoma (huge, lobulated right mandibular lymph node, tracts up to just ventral to the right ear). Possible cranial abdominal mass on radiographs. Patient has lost 10 pounds in 8 weeks. Body condtion score about 1/5, and patient is in pretty bad shape. Owners are interested in palliative care.
I'm starting pred at about 11 mg/m2 q12h (so 22 mg/m2 per day) and have placed an order for compounded CCNU (at about 74 mg/m2).
I would like your feedback on the following plan:
Owner stopped by to pick up prednisone today. They will start that immediately. CBC and Chemistry that I ran a few days ago were largely unremarkable. Mild stress leukogram and ALT around 200-250, if I remember correctly. I plan on giving the first dose of CCNU as soon as we receive it from the compounding pharmacy.
THEN, I'll have the client come back in 3 weeks. I'll run a quick in-house chemistry and CBC to make sure that ALT and neutrophils look alright. If they do, then I'll give a second dose of lomustine.
Is 3 weeks an appropriate interval? How low is too low when it comes to looking at neutrophils? How high is too high when looking at the ALT?
The owners are concerned about cost so I'm trying to make this as cost-effective as possible.
Thanks so much,
Steven
