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Featuring Demian Dressler, DVM and Sue Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide

Prednisone for Dogs: When to Start with Lymphoma

Updated: June 2nd, 2020

Summary

Prednisone for dog lymphoma may be recommended. It’s true, it treats lymphoma, and is used a lot in chemo. BUT … using it too soon could be a mistake.

prednisone for dog lymphomaUsing prednisone for dog lymphoma too soon happens all the time, so don’t beat yourself up if you’ve done it. But if you can, avoid the use of steroids (such as prednisone) before chemotherapy, and also before you have a confirmed lymphoma diagnosis.

Why? This common steroid is used in lymphoma protocols … and can also interfere with lymphoma protocols.

This is a little weird, so let me explain.

Prednisone’s Uses

Now, I’m not bashing prednisone across the board. Steroids are used for many things in veterinary medicine.

For example, your dog has probably been on prednisone. It’s a great anti-inflammatory for use with itchy skin, allergic reactions, and allergies.

Prednisone is also immunosuppressive at higher doses, which means it is great for immune disorders. That’s why it is used for things like inflammatory bowel disease and immune-mediated diseases like anemias and platelet disorders.

Prednisone is also part of most lymphoma treatment protocols because prednisone actually kills lymphoma cells. In fact, it can be a standalone treatment: if a pet Guardian decides against chemo, I recommend prednisone. Survival times for lymphoma without chemotherapy treatment are about one month, but using prednisone increases median survival times about two to three months, with about 50% response rate.

Sounds great, right? Why not start prednisone for dog lymphoma right away?

Mistake: Using Prednisone Right Away

It’s tempting for a lot of general practice veterinarians to start dogs on pred immediately if they see lymphoma on an aspirate. But this is a mistake if you are going to consult with an oncologist or use chemotherapy. Why?

Our current lymphoma protocols can be very effective. The median survival time for dogs receiving chemotherapy is thirteen to fourteen months. Compare that to one month with no treatment, or two to three months with prednisone alone, and you see why we oncologists are keen to use UW CHOP for your dog’s lymphoma.

A graph illustrating the median survival times of dogs with lymphoma on chemotherapy, prednisone only, or no treatment, as just listed in the above paragraph.

They are definitely worth a chance if you choose chemotherapy.

Which means you should avoid the use of prednisone for dog lymphoma until AFTER you have confirmed the diagnosis, and ONLY if your oncologist prescribes it.

Why? Prednisone complicates diagnostics, and interferes with chemotherapy treatments. Let’s look at diagnostics first.



Prednisone for Dog Lymphoma Complicates Diagnostics

If you start prednisone (often shortened to “pred”) before we complete other tests like chest X-rays and abdominal ultrasound, those tests will now be less accurate. Why? Because you’re already treating cancer, so we don’t know as much about the illness your dog has.

Staging Lymphoma Is Affected

For example, if your dog is already on prednisone before a liver and spleen ultrasound, that ultrasound image is not very useful. We can’t tell if lymphoma has invaded those organs or not. The lymphoma may have been there before the prednisone, or may not have been. We just can’t tell.

Why is this important? Well, how much lymphoma has spread tells us what stage cancer we’re dealing with. And knowing the stage helps us to determine treatment, monitor response, and make a more accurate prognosis about the probable outcome of treating your dog.

Side Effects Are Affected

Here’s another fact: if your dog is on prednisone before we finish testing and staging his or her cancer, he or she is probably having few side effects from the lymphoma. Of course, that’s great for the dog’s comfort, but if symptoms and side effects pop up later after we start treatment, it may be difficult for me to distinguish whether those are due to the chemotherapy or to the cancer itself. (This is one reason to see an oncologist RIGHT AWAY if you find out your dog has lymphoma!)

SubType Diagnostics Are Affected

And another thing: prednisone can affect the test for the lymphoma phenotype, also known as the subtype. There are two subtypes of lymphoma: B-Cell, which means the lymphoma is in the B-cells, and T-Cell, which means the lymphoma is attacking the T-cells. Whether your dog’s lymphoma is B-Cell or T-Cell matters, a lot: B-cells usually respond better to chemotherapy and have a longer survival time. If I can’t tell whether your dog has B-Cell or T-Cell lymphoma, I’m not going to be as accurate in my prognosis, and it will be harder for you to make a decision about whether and how to treat.

For this reason, I don’t test for the subtype if a dog is already on pred and the lymph nodes are already in remission.  The subtype test is the very best predictor we have for lymphoma: it helps us predict both the cancer’s likely response to treatment and the likely survival time we’re working with.

Lymph Node Aspirates Can Be Affected

In order to confirm your vet’s diagnosis, I take an aspirate of a lymph node. But if your dog is on pred, and the aspirate is inconclusive, we have to delay confirmation while I re-aspirate or actually biopsy a lymph node to confirm the diagnosis. This happens often when a dog has already started on prednisone before they arrive in my office.

Once again, starting prednisone before getting a diagnosis confirmation, makes getting a diagnosis a challenge.

And if diagnosis is a challenge, and I don’t have the good data I need to make a protocol choice, it can interfere with treatment.

It’s Harder to Choose a Chemo Protocol with Confidence

Knowing all of the above, particularly the B-Cell or T-Cell subtype of your dog’s lymphoma, helps me to choose which protocol to use. The UW CHOP multi-agent protocol (the best protocol we have) does not work as well for T-cells as is does for B-cell lymphomas, so the protocol has to be adjusted, and our expectations have to be adjusted, too.

I’m really flying blind — and therefore less accurate in terms of my advice — if your dog is already on pred and we can’t test for the subtype.

So, we’ve established that prednisone can really complicate diagnostics. But what about what it does to chemo treatments themselves?

Prednisone Used Too Soon Can Trigger MDR

Unfortunately, steroids like pred potentially make treatment with chemo less effective.

Prednisone can trigger a mechanism in the cells called Multi-Drug Resistance (MDR). I cover this at length in The Dog Cancer Survival Guide, because it’s an important concept for you to understand if your dog is undergoing chemotherapy for any cancer.

There’s a bunch to know, but in short, MDR is something some cancer cells can do to evade chemotherapy. Basically, some sneaky cells turn on pumps that literally eject chemotherapy agents OUT of the cell. No matter how much chemo we throw at them, they just keep throwing it back.


For more helpful tools and information, get a copy of the Dog Cancer Survival Guide


MDR can develop during normal chemo treatments, but just using prednisone alone can also trigger MDR.

As you can imagine, dogs with lymphoma who have MDR have a much worse prognosis than those who don’t.

The use of pre-treatment prednisone has been demonstrated to be a strong negative-predictor for dogs with lymphoma. In plain English: dogs who are on pred before they start chemo don’t respond as well.

Bottom Line: Wait to Use Prednisone for Dog Lymphoma

Lymphoma is a very aggressive dog cancer, and the pressure to start treatment right away is (and should be) enormous.

Every day you delay treatment is a day lost, and time is really short with lymphoma. (Most cancers do NOT have such tremendous pressures!)

However, that urge to treat does NOT mean you should start prednisone immediately.

Wait to see what the test results are. That way, you can choose from ALL of the relatively good options we have for treatment.

Jumping right in with prednisone can take options off the table.

Live longer, live well,

Dr. Sue



 

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Leave a Comment





  1. Mary Shoemaker on January 8, 2020 at 6:27 pm

    I was surprised that your article on Canine Lymphoma laid out a treatment regime that so closely paralleled the regime that I had to follow 25 years ago for MY B cell Lymphoma. I know that human and canine diseases don’t always respond to the same kinds of treatments.
    The CHOP cocktail I had for eight months included a large amount of Prednisone (100mg/day/5 days) – the “P” of CHOP. I assume that is true for canines? A pre-diagnosis dose would probably be too weak to do much good as well as muddy your diagnosis. I am happy that something that works for a human cancer, appears to fight canine cancer, too!

  2. joanne mcdonough on January 8, 2020 at 3:49 am

    best explanation ever

  3. dorothy uwekoolani on January 7, 2020 at 1:54 am

    i really appreciate your insight i had a dog die of cancer almost overnight had no where or anyone to go to as fast as i should have little signs i didnt know etc thanks again

    • Dog Cancer Vet Team on January 7, 2020 at 7:29 am

      Hello Dorothy,

      Thanks for writing and we are so sorry for your loss. Please accept our most heartfelt condolences <3

  4. Gina Hernandez on July 11, 2019 at 7:43 pm

    I just wrote a comment about my dog diagnosed with lymphoma and the vet against chemo and used one round of steroids and it was the wrong email

  5. Gina hernandez on July 11, 2019 at 7:42 pm

    My vet was not sure she was treating lymphoma … My dogs tonsils were swollen and had a bad tooth extracted so we did tests ..body blood x-rays they came out good but the next day the lymph nodes were swollen we did a biopsy and it is being sent away but she initially did one round of steroids and anabiotic‘s to try to kick teeth infection/tonsils and maybe a bacteria infection not thinking it was lymphoma. If it comes back diagnosed with lymphoma from the needle Biopsy… Is chemotherapy still out. She did not recommend chemotherapy because the pet waste is dangerous and toxic to other pets (i have a Cushings dog at home ) and toxic to humans? So I don’t know what to do!! there are so many conflicting ideas and I’m overwhelmed tonight .. and heartbroken

    • Molly Jacobson on July 15, 2019 at 10:28 am

      Hello Gina, thanks for writing, and please, stay calm! <3 You don’t know yet whether you are dealing with lymphoma or not, so panicking about how to treat it may be unnecessary. I know it’s hard, believe me! The best thing to do is to breathe, and be with your pup, and try not to overthink things until you know what you are facing. Lymph nodes swell for many reasons, not just from cancer. Until you know it’s lymphoma, try not to assume it is. Meanwhile, chemo will probably not be “out” just because your dog has had steroids to try to fight that infection. It’s just that the chemo protocols may not be as effective. Unfortunately, there is no way to know ahead of time what will “work” in any case. Even for dogs who are “perfect” candidates don’t always do as well as we would hope. Focus on your emotional management so you can absorb what your vet tells you, and don’t be afraid to get a second opinion. If your vet isn’t an oncologist, they probably won’t be able to do the chemo anyway, so IF it’s cancer, get an oncologist onboard right away if you are thinking about chemo. But that’s only IF, and hopefully, it’s not necessary. https://www.dogcancerblog.com/articles/cancer-type/lymphoma/what-i-would-do-for-my-dog-with-lymphoma/ and https://www.dogcancerblog.com/articles/choosing-treatments/diagnosis/how-important-are-all-those-expensive-diagnostic-dog-cancer-tests/ might help you out, too. And of course, if you need it, get Dr. Dressler’s book. It’s totally worth the $9.99 price tag! https://dogcancerblog.com/book

  6. Monica Tiller on April 2, 2019 at 5:50 pm

    Thank you! So much to learn in a short time. The book really helped provide a level of understanding. I got The Dog Cancer Survival Guide from the library & started Chop that day but pred. was prescribed in small doses also, eventually weining off pred. Went into remission right away. I saw the vet every two weeks for Chop. She did well for 9 months. Without a break. Wonder now if we started pred too soon.
    It’s done now. Rip

    • Dog Cancer Vet Team on April 3, 2019 at 7:30 am

      Hi Monica, Thanks for writing, and we are so sorry for your loss 🙁

      We all go through this stage where we wonder if we did the right thing, and if we could have done something else. It’s normal. The questions you are looking to answer are never going to be answered, because nothing is ever set in stone, and we don’t have a crystal ball that can see into the past, or into the future.

      So we gently offer you this advice: when you start wondering about what did or didn’t happen, remind yourself that those are thoughts that signal you are in mourning. Then, treat yourself that way. Be gentle with yourself, and feel the pain– because grief cannot be avoided, only moved through.

      Talking to a pastor, a counselor, or joining an online support group, at this time may be very helpful, too.

      You have our most heartfelt condolences <3

  7. Lynette Frederick on March 29, 2019 at 4:58 pm

    I need help. My dog had several tests and they still don’t know what she has. Can you help me? They misdiagnosed my dog. Please help us Lynette and Gucci

  8. Pam on January 23, 2019 at 6:38 pm

    I have a scenerio for you. Boxer ,10 years ,has large cancer bubble from under nose to upper lip. On long term predizone (or Predisone) and benidryl 2x a day. Question- Would a small rawhide type bone, pigs ear, or dark bone from butcher shop counter pills when said meat is chewed and in stomach. Not an every day accurance.. Alter the healing path of the medicine by being absorbed in that added substance instead of traveling to the infected area. My Son disagrees and says thats crazy-no. I say I believe it could. iIf your to eat healthy in humans
    using these meds. Dry dog food wouldnt interfer, but treated animal chews could possibly. I hope i have given you an extra bone to chew on. Thank you and good luck on this research, please really think deep about about this scenario.

  9. Karen Johnson on December 30, 2018 at 5:12 pm

    My 5 year old Yorkie was Dx with Lymphoma 6/2018. We decided to treat with prednisone. It is now 12/30/2018 he is still with us taking prednisone 5 mg BID. He has done well until the last several weeks. His breathing is like a grunting sound, his abdomen is distended. He eats all the time, drinks a lot of water. Does not seem to be in pain. But his breathing is concerning. He can still walk, run and loves to be with me. He has me up about 5 times in a night usually to go out to pee. He does get hot and like to lie on the tile. I took him to the vet last week to get his nails trimmed and to see if we needed to adjust his prednisone dose. The tech only saw he and would not trim his nails because of his breathing, she talked to me about putting him down. I am having a hard time with this because everything I have read for signs of end of live he doesn’t have other then his breathing that is not all the time. We have had 5 other dogs that we had to euthanize but they were so very sick. Or am I just trying to hold on to him. I would appreciate your thoughts. Karen

    • Dog Cancer Vet Team on December 31, 2018 at 9:29 am

      Hello Karen,

      Thanks for writing, and we’re sorry to hear about your boy. We’re not veterinarians here in customer support, so we can’t offer you medical advice. However, we can provide you with information based off Dr. Dressler’s writing

      In Chapter 25 of the Dog Cancer Survival Guide, Dr. Dressler writes that the most common question he get’s asked is, “how do I know when it’s time?” In his experience, guardians know when the end of their dogs lives are near. Some see the pleading look in their dogs’ eyes, others take an honest look at their quality of life and cannot imagine their having to live this way for much longer. Many guardians feel a click inside– a sudden realisation that it’s time to let their dogs pass. How you handle this depends upon your own beliefs, personality and desires. There is no expiration date, but there are warning signs that a dog is dying. Here’s a link to the article if you’d like to check it out: https://www.dogcancerblog.com/articles/end-of-life-care/warning-signs-dog-dying/

      It sounds like your dog’s life quality is still good, if he is still finding joy in many things, like eating and running. As Dr. D writes in this article, knowing where your dog falls on this joys of life scale can be very beneficial in determining a treatment plan, or decision.

      If you’re concerned about Life Quality and End of Life Care for your boy, you may find this article by Dr. D to be extremely beneficial as he covers how to care for your dog, what to look for, and much more.

      Once you know your options, and what is most important to both you and your dog, you will be able to make a decision based on what you think would be best. Consult with your vet, or oncologist, and don’t be afraid to ask questions! Ask about pain management, or what can be done to help his breathing. You are your dog’s guardian

      We hope this helps!

      • Vicki on August 24, 2020 at 3:37 am

        Hi – I’ve been reading all of these stories and I am wondering how you your dogs health progressed on the prednisone as mine had recently been diagnosed the same ?

  10. Susan Kazara Harper on May 17, 2015 at 10:45 pm

    Dear Becky and Maggie, All the information and articles are provided to help you navigate this journey with your vet/oncologist. It would be impossible and incorrect to comment on a specific case. Please take the information and your concerns to your vet. Remember, those professionals work for you and Maggie. You can ask to have this checked into. Professionals like to follow treatment plans which have worked in their experience, and hopefully are open to our concerns and inquiries. The decision on which plan to take ultimately rests with you, so to cosult your vet and review all the options gives you more choices. Godo luck to you both.

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