Rituxan and Prednisone

My wife has been in complete remission for 14 months from her first round of Rituxan. These doses of Rituxan were given to her as she was tapering off prednisone. Today she had a routine blood count and her platelets appear to be dropping again. It seems probable she will have another round of Rituxan infusions. My question is whether it is standard protocol to be on prednisone when Rituxan is being administered. Would obviously like to not go through the prednisone dosage and taper again if not necessary. Just curious on what others experience has been before her hematologist appt.

I tapered off Prednisone prior to my Rituxan treatments. I had 16 months of remission with my first treatments and almost 3 years with the second round.

I've had good previous results with rituxin but my last round didn't work. I think I have had it at least 5 times over the last I don't know how many years with my best remission being almost two years. I had the prednisone and had to do the taper. Good luck to you!

Two things - no prednisone is not standard pre-treatment for Rituxan - if you anticipate infusion reactions then it is sometimes used for that.
Second - the platelet drop may not continue. I've had a sustained remission from Rituxan for 3.5 years now and I've had a few drops (from over 200 to close to 100) over that time and have gone back up by myself. I didn't expect to go back up on my own, I was already planning with my doctor another course of treatment.
Erica

Dean -
Thanks for your response. Rituxan worked so well for my wife the first time around - immediate response after the first infusion and no side effects. We are hoping for another successful experience.
Jim

Erica -
The first time around, my wife was at 10mg/day prednisone when her platelets dropped and she started Rituxan. She had no side effects from the infusions. We weren't sure if the no side effects was because she happened to be on Rituxan. We'll discuss with her hematologist leaving her off prednisone if she has another round and see what happens.

Thanks for sharing your experience about your platelets bouncing around. Since she finished Rituxan last year her platelet counts have been very consistent in the 230 to 250 range. Yesterday it was 151 - still a good number but not where it normally is. Your experience gives us some hope that this is just a temporary dip. Probably get a re-check in a month or so and see where we are. Thanks again,

Jim

Jim:

Prednisone and Rituxan can be used together but it's not necessary nor is it protocol. A person may have fewer Rituxan side effects if they are on Prednisone at the time, not the other way around.

My first round of Rituxan lasted me exactly 14 months and I was back in the 20's. Another infusion (just one) took me to over 150. I've had a few drops into the 60's but rebounded on my own and have been in remission for 7+ years.

Thanks for the response, Sandi. You seem like you've had a great response to Rituxan! Have you been on prednisone during your remissions? Just curious.

Jim

jaing50 wrote: Erica -
The first time around, my wife was at 10mg/day prednisone when her platelets dropped and she started Rituxan. She had no side effects from the infusions. We weren't sure if the no side effects was because she happened to be on Rituxan. We'll discuss with her hematologist leaving her off prednisone if she has another round and see what happens.

Thanks for sharing your experience about your platelets bouncing around. Since she finished Rituxan last year her platelet counts have been very consistent in the 230 to 250 range. Yesterday it was 151 - still a good number but not where it normally is. Your experience gives us some hope that this is just a temporary dip. Probably get a re-check in a month or so and see where we are. Thanks again,

Jim

Jim, what were your wife's counts prior to the Rituxan? 151 is not bad and needs no treatment. Probably just a temporary dip. I bounced around alot. Responded better with the second round.
Agree with the recheck in a month or so.
Take Care!!

Yes, I have been on Prednisone for the last 7 years (not for ITP). I've been on varying doses between 15 and 40 mg's a day, so that could also be keeping my counts up. Don't know.

Dean - My wife's history with ITP started in Sept. 2010 when her platelet count went to below 10k. She responded well to IVIG and prednisone. The prednisone would keep her counts up in the 230-250 range until she dropped below 10mg/day. The second time this happened, her counts went down to 17k and she then started the rituxan. The nature of her ITP seems to be she's either in the 230-250 range or she drops to less than 10. Doesn't seem to hold counts between the two levels. That's why the concern about the recent 150 reading. Don't get me wrong - it's a great number and she has no bruising or other symptoms. Latest update from her hematologist is to re-check in about 2 weeks. Then we'll know what we're dealing with.
Jim

Good Luck!!!

Thanks, Dean - We're hoping for a good number but even if it's falling, I'd like to think she will get an even longer remission to a second round of rituxan like you, Sandi, and others have.

Jim

My son 11 years old, undergo Rituxan 1st round (4 doses in 4 weeks) only ...no effect at all!! platelet remains low at 1k to 5k. We are not considering 2nd dose, as we are afraid of side effects..

Just taking Green Barley (chlorophyll), food supplement!

Evicar - it's too soon to know if Rituxan worked yet. It can take 4 to 12 weeks after the first infusion to see a response.

If he got through the first one okay, he should be okay for the rest.

I tried chlorophyll when I was newly diagnosed...waste of money. My counts just went down.

Agree with Sandi. Rituxan can take several weeks before results can be seen. I would consider finishing the treatment. Being he got through the first treatment fine, chances are the other 3 will be fins also.

Well, my wife's latest count (today) is 91k. She was at 151k 3 weeks ago and consistently around 250k prior to that. It would appear she's dropping at a fairly steady rate. Will be discussing what course of action to take with her hema this week. Round 2 of Rituxan seems a real possibility.

I done had 3 rounds of Rituxan as an out patient while on Prednisone. It didnt help me my platelet still would fall from one treatment to the next.. last week I had my spleen taken out and my platelets went up to 97,000 only to fall back down to 30,000 3 days later.. this coming Wednesday is another Dr visit and already knw be getting another treatment. This is all new to me. I just found out a month ago I had ITP and spent 3 of those weeks in the hospital cause my platelets was at ZERO !!!.. Good luck to her

Hope things are going ok for you jchrism8. Any new treatments? As for my wife, she had a CBC several days ago and her platelets continue to drop - to 59k from 91k several weeks before. She has yet to show any bruising or other symptoms, so we're in a watch and wait mode. Probably wishful thinking, but maybe there's still a chance the platelet count will level off. If they continue to fall, we want to give Rituxan another try since she had a complete response that lasted 15 months and she had no side affects from the infusions.