TOPIC:

my son treated first time with 375 mg and was in remission for almost 15 months and repeated with low dose and almost 15 month remission but i don't know how many time the person can be repeated in his life ? my son still 23 years .

I don't think anyone really knows, Farida. I do know that some people have had more than 3 rounds. Not many, but a few. Are his counts low again?

yes Sandi 11k and started cortisone , his count now is 22k , he took it 2 days only and stopped it ,

Rituximab is used repeatedly for other conditions, including rheumatoid arthritis. For ITP patients, I don't think it has been studied beyond one repetition. It was shown that rituximab is 75% effective in repeat patients who responded to their first treatment.

I just meant that Rituxan hasn't really been around long enough to know the long term side effects from repeated doses. That might be a very hard thing to pin point anyway.

my son's count went down 2 weeks to49k and then to 39 on the second week , his doctor asked him to start Rituxiab again , he started first dose last Friday , and today he got his second dose and his doctor did cbc before the infusion , his cbc was 600 k , but his doctor gave him the second dose , i don't know why and ? can his platlets go up from first round , i don't know any think , and last week he suffered from sever headache after the infusion , but it went away in the morning , so worry about him ,

i wish somebody read my message and give answer .

Farida, my counts did go up from the first dose of Rituxan. It is rare. I'm not sure why if his counts were 600K he still got the second dose. I was surprised when I got my fourth infusion as my counts were in the 300K range.

he is the same too , this is the third time he is repeating Rituxan , i know it takes at least 1 month to kick in and they give steroid with Rituxan , my son's count up and down , 2 month it went down to 11 k and he got i pill of predneson 60 mg ,his count went up normal and he didn't quntinu the prednison , two month after cbc 39k and he rushed himselef to take Rituxan so he can focuse in his study . no body knows

Farida - most of us were sleeping when you posted.

Some doctors think they have to do all four rounds no matter what the counts are. It's not true and he doesn't have to do the rest if he doesn't want to.

as you know Sandy , he is in the medical school , he dose not listen to me anymore , but his main concern just his studies and exams , he wants to get stable count and forgot the issue for a while , but he had sever headache last Friday after the first dose . and he has to do cbc Monday , no body knows if the heigh count from the Rituxan or it could go up by itself ,
going to see him today , and i hope everything is good . thank you Sandi

Being in medical school he should realize that such a drastic increase in count, from 39k to 600k, is not good!

I'm with Cindy - why would his doctor give him Rituxan when he had a count of 600k?
(I thank you Cindy)

Okay then. Our future doctor may not listen to you, but maybe he would take these studies into consideration:

www.haematologica.org/content/90/2/281.abstract?ijkey=78873704fe05255bc16d48afd15c9d680f85e6e1&keytype2=tf_ipsecsha

www.haematologica.org/content/93/6/930

www.haematologica.org/content/92/12/1695

These articles discuss that a lower dose of Rituxan can yield the same results as the standard dose, but only having one or two infusions can also produce lasting results. I had one infusion in 2004, counts responded and I have not had to treat ITP since.

I would prefer to spare myself the toxicity if possible.

his count is 700k he just told me when i saw him today , he did not like me freaking out , his doctor told him if its over 800k he will consider giving him aspirin . he will do other cbc on Monday , he looks fine .

my son doesn't have spleen Melinda , he had cold also . his count is 700k he just told me now , this is the result is from yesterday , he wouldn't like to tell me until i see him today ,he knows that i will be shocked . thank you for your reply , we will wait till Monday .

i agree with you , he is taking the low dose ,100 mg , i will see what is going on Monday .

I don't know why being without a spleen would make the doctor want him to have another Rituxan when his count was at 600k.

And regarding the aspirin you were asking about in another thread - I'm not in the medical field so I could not tell you yes it is ok to take aspirin with his count so high or no it is not ok for him to take aspirin with his count so high. Wouldn't be right for me to say yeah take aspirin and then him have problems - or for me to say no don't take it and then he has a stroke or other problems. He really needs to be talking to his doctor and going from there. What year of medical school is your son in? Is he at a place in hematology studies where he can be treating/diagnosing himself?

his count is 570 k today , no need for asprin , he is in first year , his doctor is busy most of the time , he is following with him by phone , thank you for your reply .

The latest meta-analysis of 12 studies, 869 patients:
Biomed Res Int . 2021 Oct 6, 2021:9992086. doi: 10.1155/2021/9992086. eCollection 2021.
The Efficacy and Safety of Different Dosages of Rituximab for Adults with Immune Thrombocytopenia:
A Systematic Review and Meta-Analysis
Yu Dong , Ming Yue , Mengjiao Hu
PMID: 34660807 PMCID: PMC8514896 DOI: 10.1155/2021/9992086
Abstract
Background: Rituximab has been frequently used as a second-line treatment for patients with immune thrombocytopenia (ITP). The optimal dose and course of rituximab are uncertain.
Methods: A comprehensive search for randomized controlled trials reporting the use of low-dose (100 mg) or standard-dose (375 mg/m2) rituximab in ITP treatment was conducted. Meta-analyses were performed on CRR (complete response rate), ORR (overall response rate), PRR (partial response rate), SRR (sustained response rate), infection rate, SB (significant bleeding) rate, and SAE (serious adverse event) rate.
Results: A total of 12 studies were included, comprising 869 patients. Compared to the control group, rituximab treatment resulted in an obvious increase in CRR (P < 0.00001), ORR (P < 0.0001), and SRR at month 6 and 12 (P = 0.0007, P = 0.0003), without increasing the infection rate (P = 0.12) and SAE rate (P = 0.11). No significant differences in CRR (RR 1.61 vs. 1.42, P = 0.45), ORR (RR 1.26 vs. 1.49, P = 0.28), PRR (RR 1.25 vs. 1.00, P = 0.11), SRR at month 12 (RR 2.00 vs. RR 1.64, P = 0.54), infection rate (RR 0.85 vs. 1.46, P = 0.36), and SB rate (RR 0.14 vs. 1.19, P = 0.17) were found in subgroups of low dose and standard dose.
Conclusion: Rituximab was effective and safe for adult patients with ITP. A low-dose rituximab regimen might be an effective alternative to the standard-dose regimen in ITP, as it showed similar CRR, ORR, and SRR at month 12 and was relatively safer with a lower cost.