Aggressive Lymphoma in 16 year old Diabetic - advice?

I've been struggling with my decisions and wanted to find out if anyone has experience with aggressive lymphoma that involves an enlarged spleen in diabetic cats? If so, what treatment did you do and what was the outcome?

My cat turned 16 last month and we were concerned he might have lymphoma given decreasing white blood cells over the past few tests. This isn't small cell lymphoma which is easily treated - this involves the spleen and liver. The ultrasound showed enlarged spleen.

He has been a well controlled diabetic for 6 years. He has IBD and has been on budesonide. He has kidney disease. His creatinine had gone up to 4.6 and with weekly fluids and fish oil decreased to 3.8. His bun is still high in the 80s.

He has a cardiomyopithy for which I give him ubiquinol (co-enzyme)

He has arthritis for which he gets supplments.

He has multiple food and drug sensitivities. Lecithin used in food makes him vomit. We tried calcitriol and he became lethargic - he has problems with oils and I have to give very small amounts of fish oil because he cannot tolerate regular doses. He has had negative reactions to clavamox caused vomiting, adequan gave him diarrhea, and there was one other med he couldn't tolerate which escapes me at the moment.

He also has some sort of facial tick that developed 4 years ago. He had to have his teeth removed 2 years ago because of tooth resorption - for which there is no prevention or other treatment.


My vet is very concerned about his age, health problems and sensitivities. She also said this is an aggressive cancer and may or may not respond to chemo. She has cats that have outlived prognosis and others that didn't respond at all. Her biggest concern is that he would stop eating and we would spiral into other problems. In addition - she worries about his heart and kidneys because chemo can be hard on them. She said we could do a few treatments and then if he doesn't respond well, we could stop. If I pursue further treatment, we still need to have a full ultrasound and biopsy of tissue with a needle.

He does have some fluid around his heart and stomach - but not enough to be drained. He just started injectable steroids - dexamethasone. He is also on Milk Thistle and AHCC (mushroom extract).

I love Gus more than anything. I just don't want to make his last days hell on earth but I also don't want to miss an opportunity to give him a longer life. Does anyone have any experience with aggressive lymphoma in older cats with other existing health problems and if so - what was your decision and the outcome?

Thank you for any and all input.

 

What kind of lymphoma? Was it diagnosed with a biopsy?
Large-cell lymphoma is categorized as aggressive and treatment is surgery/chemo and prednisolone.
Small-cell lymphoma is slow growing and is usually treated with prednisolone and oral leukeran.
You said he has cardiomyopithy "He does have some fluid around his heart and stomach". You said he started steroids. Steroids is usually contraindicated for those problems.

I adopter Marion when he was an untreated, 15 year old diabetic. Shortly afterwards he was diagnosed with small-cell intestinal lymphoma. I treated him and he had two more years of a good life.

 

We have not done a biopsy. My vet is confident it isn't small cell lymphoma because he has an enlarge spleen. The spleen isn't enlarged with small cell.

The fluids around the heart and stomach are due to lymphatic fluid - not the cardiomyopathy. My vet said the steroids could clear up the fluids.

Does anyone have any experience with the more aggressive types of lymphoma in older cats?