Immunosuppression and Infection

Good day to everyone, wishing you all the best.
I am looking at Rituxan for re-occurring low counts.
I asked my hemo , "is it true that more patients die from immunosuppression that ITP bleeds",
she answered with a swift and sure "yes".
Is that maybe because the stats include everyone who has done Rituxan with comorditieis?
I have allot of trouble with little annoying infections already due to my wonky immune system.
Sinus, bladder, thrush. (I am on pred all the time)
Is there any information regarding treatment with Rituxan and subsequent infection?
Any experiences on this forum?
What is the point doing the Rituxan if after there will be no ability to fight inevitable infection
for over a year after?
Can there actually treat these infections at all if they come up?
How does one avoid infection after Rituxan? What has everyone been told during treatment?
thanks Sandy Too

Hi Sandy Too, I did Rituxan back in 2011 and have had a few infections, mostly in my mouth where I have had teeth removed. I was told to go to the hospital or my doctor immediately for fevers or infections, but I'm not like that. It takes a lot to make me go to the hospital. I have not had any major infection since doing the Rituxan.

Sandy - everyone is different. Some people might not have any problems with infections, but it depends on how healthy the person is to start with and what other meds they might be taking. As I've said before, we had a woman here die from sepsis within 24 hours of getting sick. She didn't have a spleen, was on Prednisone and had just finished Rituxan. Someone who is young and healthy and gets Rituxan will probably be just fine. You have to decide where you fit in.

I don't remember any studies about Rituxan and infections, specifically. Most of the stats I've seen relate to overall infections with all treatments.

I'm also having problems with infections that don't go away. Every time I've used immunosuppressants (Imuran, CellCept, MTX), I end up really sick with pneumonia or bronchitis. I've refused them for years because of this. I'm also on Prednisone (15 mg's) and have low white cells. After Rituxan, I had no problems with infections, but I didn't have Lupus then and wasn't taking any other meds. It all depends on the situation.


www.iwmf.com/sites/default/files/docs/Rituximab-Associated_Infections-Seminars_in_Hematology.pdf

Sandy,

Ellen works in an AIDS clinic, and is exposed to every opportunistic infection you can imagine. Prior to Rituxan she fought off two MRSA infections, but none after taking Rituxan. Her hematologist was not concerned for Ellen's risk, based on past experience with other patients.

I suppose that Rituxan only targets specific B-cells that only fight certain illnesses, or types of illnesses. There are specific illness listed that can be reactivated by Rituxan, according to the product literature.

I didn't have any problems with infections or getting sick after rituxan.
Erica

Here is some info on B Cells:

The B lymphocyte cell searches for antigen matching its receptors. If it finds such antigen it connects to it, and inside the B cell a triggering signal is set off. The B cell now needs proteins produced by helper T cells to become fully activated. When this happens, the B cell starts to divide to produce clones of itself. During this process, two new cell types are created, plasma cells and B memory cells.

The plasma cell is specialized in producing a specific protein, called an antibody, that will respond to the same antigen that matched the B cell receptor. Antibodies are released from the plasma cell so that they can seek out intruders and help destroy them. Plasma cells produce antibodies at an amazing rate and can release tens of thousands of antibodies per second.

When the Y-shaped antibody finds a matching antigen, it attaches to it. The attached antibodies serve as an appetizing coating for eater cells such as the macrophage. Antibodies also neutralize toxins and incapacitate viruses, preventing them from infecting new cells. Each branch of the Y-shaped antibody can bind to a different antigen, so while one branch binds to an antigen on one cell, the other branch could bind to another cell - in this way pathogens are gathered into larger groups that are easier for phagocyte cells to devour. Bacteria and other pathogens covered with antibodies are also more likely to be attacked by the proteins from the complement system.

The Memory Cells are the second cell type produced by the division of B cells. These cells have a prolonged life span and can thereby "remember" specific intruders. T cells can also produce memory cells with an even longer life span than B memory cells. The second time an intruder tries to invade the body, B and T memory cells help the immune system to activate much faster. The invaders are wiped out before the infected human feels any symptoms. The body has achieved immunity against the invader.

www.nobelprize.org/educational/medicine/immunity/immune-detail.html


Types of B-cells

Naïve B-cells: Naïve B-cells are present in the bloodstream. They are mature B-cells that have not been exposed to an antigen yet. These cells have antigen-specific antibodies immunoglobulin M (IgM) and immunoglobulin D (IgD) on their surfaces. These naïve B-cells are able to recognize their cognate antigen. Since there are millions of B-cells in the body, and naïve B-cells only live a few days, more than 90% of these cells die before they come into contact with an antigen.

Plasma B-cells: Plasma B-cells, or plasma cells, are large B-cells that have been exposed to an antigen. They secrete large amounts of antibodies. They are sometimes called antibody factories. Plasma B-cells have large amounts of rough endoplasmic reticulum, which is a system of membranous tubes and sacs containing ribosomes that produce the membrane-bound antibodies. These plasma cells are found in the spleen and lymph nodes.

Memory B-cells: Memory B-cells are formed from activated B-cells. These cells are specific to an antigen that has previously entered the body. Memory B-cells, which are present in the bone marrow, lymph nodes, and spleen, are able to respond quickly when they are exposed to the same antigen in the future. Lower levels of the antigen are able to activate memory B-cells better than naïve B-cells. Therefore, the memory B-cells enable the immune system to react more quickly if their cognate antigen enters the body in the future. Memory B-cells have a prolonged life span and they can survive for many years (up to a lifetime).

B-1 cells: B-1 cells express the CD5 protein on their surfaces, which can bind to another protein called CD72. It has been suggested that the CD5-CD72 link mediates interaction among B-cells.
B-1 cells express more immunoglobulin M (IgM) than immunoglobulin G (IgG) and their receptors show polyspecificity. This means that they are able to identify several different antigens if they are present in high quantities. However, they have a preference for other immunoglobulins, self-antigens, and common bacteria. These cells respond to antigens that are T-cell independent. This means that the B-1 cells are activated without the help of T-cells.
Most B-1 cells are found in the abdominal and chest cavities. Low quantities of B1-cells are also found in the lymph nodes and spleen.

B-2 cells: B-2 cells are considered conventional B-cells. They respond to antigens that are T-cell dependent. This means that T-cells are needed to activate the B-1 cells.

www.wellness.com/reference/allergies/b-cells

Those are some really good links Sandi.

I have looked for a cogent full description of the immune system and couldn't find one. These are best I've seen.

Now if they had only spoon fed me info on how Rituxan affects all that, LOL
B memory cells (and T memory) are supposed to last years. Ack !

One thing I really like about that pdf file Sandi, is this part:
"
Rituximab administration results in profound depletion of normal B cells for several months, but immunoglobulin levels remain unaltered in most patients. This is thought to be due to the fact that long-lived plasma cells do not express CD20. The lack of effect on immunoglobulin levels suggested that rituximab administration could have minimal effect on the occurrence of infections.
"

With 'minimal effect', guess there is no special need to stay away from large public groups

Right. In layman's terms: B Cells go through certain stages of growth and with each stage, they are labeled with a "CD" number. Rituxan only targets CD-20 Cells, which means that only B cells in that certain stage are destroyed. The other B cells survive. This is important because B cells are the 'memory' cells; they remember the illnesses you've had in the past. It's a very important part of overall immunity.

To understand the immune system, you should just search 'immune system 101'. That's what I did when I was learning. Start with the basics. You'll find that it's much more complex than you ever imagined.