Multidrug
Sensitivity Genotyping (MDR1)

ImpriMed offers personalized medicine services to help you diagnose and treat canine lymphoma or leukemia.  We offer 4 levels of service:

• The Personalized Prediction Profile includes our complete Immunoprofile diagnostic report and anticancer drug response predictions generated by artificial intelligence models.
  
• The predictions include estimates of both (1) the likelihood of a positive clinical response (partial response/ complete remission) to individual anticancer drugs and (2) the likelihood of complete remission and relapse with traditional CHOP combination therapy.
• Outcome predictions are currently provided for 13 individual drugs that are commonly used in many first line and rescue protocols for the treatment of canine lymphoma (including CHOP, LOPP, MOPP, LPP, Tanovea® only, etc…).
• Predictions are included for Doxorubicin, Cyclophosphamide, Vincristine, Vinblastine, Prednisone, Rabacfosadine (Tanovea®), L-Asparaginase, Lomustine, Mitoxantrone, Mechlorethamine, Dexamethasone, Chlorambucil, and Melphalan.

• The ImpriMed Immunoprofile service includes both our Flow Cytometry and PARR reports.
  
• These comprehensive results can be used to detect the presence of lymphoma or leukemia and determine the disease subtype.

• ImpriMed offers a unique precision oncology service that helps you to find the best anticancer drugs for your patients.
  
• ImpriMed directly tests a panel of commonly used anticancer drugs on your patients’ live cells in our A2LA accredited lab.¹
• In addition, we continually collect patient outcomes that are updated via regular follow-up with pet parents.
• As our database grows, so does the performance of our anticancer drug response predictions and your ability to develop a personalized treatment plan for each pet patient.
• So, when you order an ImpriMed service, you are actively contributing to our dataset and helping to improve cancer care for your patients and the ImpiMed user community.

• A drug sensitivity test is a lab test that measures how easily cells are killed by a drug.
  
• When you order a Personalized Prediction Profile, ImpriMed uses a proprietary high-throughput ex vivo drug sensitivity testing platform to analyze your patient’s live cells.
• For our canine lymphoma and leukemia service, we expose the cells to 13 different drugs commonly used to treat these diseases: L-Asparaginase, Mitoxantrone, Vincristine, Vinblastine, Doxorubicin, Rabacfosadine (Tanovea®), Chlorambucil, Mechlorethamine, Lomustine, Prednisolone (activated Prednisone), Mafosfamide (activated Cyclophosphamide), Melphalan, and Dexamethasone.

Currently, our services are for canine lymphoma and leukemia.  We will be expanding our services to other species and other blood/lymphoid cancers in the near future.

• Our predictions are made by artificial intelligence (AI) models trained to predict clinical outcomes from patient data inputs.
  
• Clinical outcomes collected from oncologists include reports of progressive disease, stable disease, partial response, and complete response.
• Patient data used as inputs for by the AI models include readings from our live-cell drug sensitivity assay, flow cytometry, PARR, and patient information.
• Models are re-trained periodically to incorporate new data and refine performance.

• Our flow cytometry, PARR, and Immunoprofile reports are emailed to you 3-4 days after receipt of your patient’s sample(s)at our lab.
  
• The Personalized Prediction Profile reports are emailed to you 6-7 days after receipt of your patient’s sample(s) at our lab.

• To get started, first register on our Vet Portal. You can order both services and supplies online: https://www.imprimedicine.com/vetportal
  
• For portal support via phone call us at 650-521-0165 or for support via email please write to us at info@imprimedicine.com
  
• We will send you a starter kit (transport media tubes, prepaid shipping boxes, and packing materials) within 1 business day.
  
• Once you’ve received the kit and materials you are ready to go; you can collect patient samples and ship them to ImpriMed via FedEx overnight. We are open 6-days a week to accept samples (Monday through Saturday).

• For canine lymphoma, please provide a fine need aspirate (FNA) sample and a blood sample for each patient.
  
• For canine leukemia, only a blood sample is required.
  

 ImpriMed steps for FNA collection – Please watch the video here or read on

1. Disinfect the skin with alcohol (70%) at the planned needle puncture site.
   
2. Insert a 20-gauge needle (without syringe) into an enlarged lymph node and perform 15 - 20 aspirations using an aggressive “woodpecker style” technique. Stop aspirating when the aspirate appears in the hub of the needle.
   
3. Attach the needle to a 5 - 10 mL syringe (with at least 1 ml of air). Tilt the collection tube upside down and inject the aspirated material directly into the medium.
   
4. Allow a small amount of fluid (~1/4 mL) to flush back into the needle, then gently reinject into a fluid medium to flush out the needle.
   
5. Repeat the procedure multiple times to ensure all the aspirate is transferred into the media tube. We need at least 10 million cells to conduct the drug response predictions, so if you need to aspirate from other affected nodes please do so. There are no additional costs for additional nodes or tubes. Typically, 2 FNA tubes of adequate cellularity are required to reach 10 million cells. If a blood vessel was lacerated during the procedure and the collection tube becomes significantly bloody, please select a different biopsy site and repeat the procedure. Store any FNA tubes in the fridge immediately after the biopsy. DO NOT freeze samples or the transport media.
   

• We also accept fresh lymph node tissue and spleen samples (within 24 hours of collection).
  

The cell counts required for each assay are below:

• Personalized Prediction Profile: 10 million
  
• Immunoprofile: 1 million
• Flow cytometry: 700,000
• PARR: 300,000

For more information on lymph node cytology click here: https://todaysveterinarypractice.com/lymph-node-cytology-what-should-should-not-be-there/

• ImpriMed’s flow cytometry report provides comprehensive information about the specimen’s immunophenotype.
  
• B-cell and T-cell immunophenotypes are useful in determining lymphoma/leukemia subtype and prognosis.
• In addition, our panel of ten antigens can also be used in the diagnosis of T-zonal lymphoma, acute leukemia, and other diseases.
• Antigens levels reported are: CD21, CD79a, CD3, CD4, CD8, CD5, CD45, CD34, CD14, and MHC class II.

For more information, see: https://pubmed.ncbi.nlm.nih.gov/26953614/

• PARR, which stands for PCR for Antigen Receptor Rearrangements, is used to discriminate between lymphoma/leukemia and reactive/inflammatory conditions when cytology is equivocal.
  
• Our canine PARR assay detects the expansion of B-cell cancer clones by amplifying the VJ region of the immunoglobulin heavy chain gene (IgH) and detects the expansion of T-cell cancer clones by amplifying a region in the T-cell receptor gamma chain gene.³

• The more samples ImpriMed processes and the more clinical outcomes we receive from our customers, the more accurately our AI models are able to determine which drugs will work best for your patients.
  
• If you believe the ImpriMed Personalized Prediction Profile may help you to identify the most effective treatments for a patient, be sure to notify the pet parents that this service is an option for them.
• One of the huge benefits of AI-led diagnostics like ImpriMed is the ability to be constantly developing and improving based on the feedback of existing cases. This prospective approach to the evolution of the assay improves the accuracy and therefore the applicability for all patients. Because of this philosophy to constantly improve the service; we try to reach out to our clients a few months after a test is run to gather basic data on how the test performed. We have developed a simple standardized form to make this as easy as possible and we appreciate your support in advance. If you have any concerns over the test, this ensures we can address them to help improve the service you are able to offer your clients.

Please contact sales@imprimedicine.com to request pricing information. We will get back to you within 1 business day.