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25μ£Ό CHOP/CEOP νλ‘ν μ½μ μ£Όλ‘ κ° μ€μ¦λ λ° κ³ μ μ±λ λ¦Όνμ’ μΉλ£μ μ¬μ©λλ νμ€ λ€μ λ³μ© νμννμλ²μ λλ€. μμ© κΈ°μ μ΄ λ€λ₯Έ μ½λ¬Όλ€μ κ΅λλ‘ μ¬μ©νμ¬ μ€λ³΅λλ λ μ±μ μ΅μννλ©΄μ μ’ μ μΈν¬ μ¬λ©Έμ κ·Ήλνν©λλ€. > **μ€μ κ²½κ³ :** λΉν¬λ¦¬μ€ν΄κ³Ό λ μ루λΉμ /μνΌλ£¨λΉμ μ μ¬κ°ν **λ°ν¬μ± μ½λ¬Ό(μ‘°μ§ κ΄΄μ¬ μ λ°)**μ λλ€. λͺ¨λ νμΆμκ² μ λ§₯ μΉ΄ν ν°λ₯Ό μ₯μ°©ν΄μΌ νλ©°, λ¨λ²μ μ±κ³΅μ μΌλ‘ μ₯μ°©λ μΉ΄ν ν°λ§ μ¬μ©ν΄μΌ ν©λλ€. μ½λ¬Ό μΌμΆμ΄ λ°μνλ©΄ μ¦μ μ’ μ μ λ¬Έ μμμ¬μκ² μ°λ½νμμμ€. **μμ ν:** νΈλ‘μΈλ―Έλλ μν΄λ‘ν¬μ€νλ―Έλμ ν¨κ» ν¬μ¬λμ΄ μ΄λ¨ μμ©μ μ λνλ©°, λ μ± λμ¬μ°λ¬Ό(μν¬λ‘€λ μΈ)μ΄ λ°©κ΄ μ λ§κ³Ό μ μ΄νλ μκ°μ ν¬κ² μ€μ¬ λ¬΄κ· μ± μΆνμ± λ°©κ΄μΌμ μνμ μ΅μνν©λλ€.
μμ© κΈ°μ : This protocol relies on the synergistic action of four distinct drug classes: * **Cyclophosphamide:** Alkylating agent β cross-links DNA strands, preventing replication. * **Doxorubicin/Epirubicin:** Anthracycline antibiotic β inhibits **topoisomerase II**, intercalates DNA, and generates free radicals. * **Vincristine:** Vinca alkaloid β binds to **tubulin**, inhibiting microtubule formation and arresting cells in metaphase. * **Prednisolone:** Glucocorticoid β induces apoptosis in lymphoid cells.
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- Lymphoma (CHOP/CEOP Protocol - Vincristine) Β· 0.7 mg/m2 Β· IV Β· once Β· Weeks 1, 3, 6, 8, 11, 15, 19, 23 Β· Strict first-stick IV catheter only. Vesicant.
- Lymphoma (CHOP/CEOP Protocol - Prednisolone) Β· 2 mg/kg (Wk 1); 1.5 mg/kg (Wk 2); 1 mg/kg (Wk 3); 0.5 mg/kg (Wk 4) Β· PO Β· q24h Β· First 4 weeks only, then stopped Β· Tapering dose.
- Lymphoma (CHOP/CEOP Protocol - Cyclophosphamide) Β· 250 mg/m2 Β· PO/IV Β· once Β· Weeks 2, 7, 13, 21 Β· Administer with Furosemide.
- Lymphoma (CHOP/CEOP Protocol - Furosemide) Β· 1 mg/kg Β· PO Β· q12h Β· For 48h (4 doses) concurrent with cyclophosphamide Β· To prevent haemorrhagic cystitis.
- Lymphoma (CHOP/CEOP Protocol - Doxorubicin or Epirubicin) Β· 30 mg/m2 (Use 1 mg/kg for patients <15 kg) Β· IV Β· once Β· Weeks 4, 9, 17, 25 Β· Give in 0.9% NaCl (not Hartmann's) over 20 minutes. Vesicant.
- Lymphoma (CHOP/CEOP Protocol - Maropitant) Β· 1 mg/kg Β· SC Β· once Β· Prior to doxorubicin/epirubicin Β· Anti-emetic premedication.
- Lymphoma (CHOP/CEOP Protocol - Omeprazole) Β· 1 mg/kg Β· PO Β· q12h or q24h Β· First 21 days Β· GI protectant. Ranitidine with sucralfate is an alternative.
- Lymphoma (Alternative to Cyclophosphamide - Chlorambucil) Β· 20 mg/m2 Β· PO Β· once Β· As needed Β· Used if haemorrhagic cystitis develops.
- Lymphoma (Alternative to Doxorubicin - Mitoxantrone) Β· 5.5 mg/m2 Β· IV Β· once Β· As needed Β· Given over 10 minutes. Used in cases of cardiac dysfunction.
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- Severe myelosuppression (neutrophil count < 3 x 10^9/l)
- Pre-existing severe cardiac dysfunction (relative contraindication for doxorubicin; use mitoxantrone instead)
- Active haemorrhagic cystitis (substitute cyclophosphamide with chlorambucil)
- MDR1 mutation (requires significant dose reduction or avoidance of vincristine and doxorubicin)
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- Myelosuppression (neutropenia, thrombocytopenia)
- Gastrointestinal toxicity (vomiting, diarrhea, anorexia)
- Haemorrhagic cystitis (specific to cyclophosphamide)
- Severe tissue necrosis if extravasated (vincristine, doxorubicin)
- Cardiotoxicity (specific to doxorubicin)
- Alopecia (breed dependent)
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- Cimetidine Β· Alters hepatic cytochrome P450 enzyme pathway, potentially altering the metabolism and increasing toxicity of chemotherapeutics. Β· major
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- Haematology prior to each treatment
- Nadir neutrophil count 7 days after the first doxorubicin treatment
- Free-catch urine dipstick prior to each cyclophosphamide administration (check for blood)
- Urine culture if blood is noted on dipstick
- Biochemistry prior to first treatment and minimum every 6 months
- Baseline echocardiography (especially before doxorubicin if pre-existing heart disease is suspected)
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Overdosage of any component of the CHOP protocol can lead to **life-threatening myelosuppression** (profound neutropenia and sepsis), severe gastrointestinal mucosal sloughing, and acute cardiotoxicity (doxorubicin). Treatment is strictly supportive, including broad-spectrum IV antibiotics, aggressive fluid therapy, anti-emetics, and potentially granulocyte colony-stimulating factor (G-CSF).
VetSheet μ½λ¬Ό λ νΌλ°μ€λ λ©΄ν μμ μ λ¬Έκ°λ₯Ό μν μμ μμ¬κ²°μ 보쑰 λꡬμ΄λ©°, μ λ¬Έμ νλ¨μ΄λ μ μ‘°μ¬μ μ΅μ λΌλ²¨μ λμ νμ§ μμ΅λλ€.